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HomeMy WebLinkAbout113033 GENERALCARE HEALTH SERVICES INC - INSURANCE CERTIFICATE (2)OP ID: VM CERTIFICATE OF LIABILITY INSURANCE AT12/291YYYY) r2/29/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. IUSUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - - - 970-635-9400 PFS Insurance Group DBA LBN Insurance Agency 970-635-9401 484&Thompson Pkwy, Ste 200 - Johnstown, CO 80534 Shawn WOtOWey - CONTACT PHONE FAX A/C No Ext : A/C No): , E-MAIL ADDRESS: PRODUCER GENER-7 CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED Generalcare Health Services, Q �/"�' Inc. V INSURER A: Hartford Insurance Co. 00914 INSURER B : Plnnacol Assurance CO 41190 Generalcare Physicians Group, 1 1 620 S. Lemay Avenue Fort Collins, CO 80524 INSURER C : INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X 34SBAIR0214 - 01/01/11 - - 01/01112 EACH OCCURRENCE $ 1,000,000 FAMAGE TO RENTED REMISES ea occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ _ 1,000,000 GENERAL AGGREGATE,., $ 2,000,000 GE "L AGGREGATE LIMIT APPLIES PER: POLICY E PRO LOG PRODUCTS - COMP/OP AGG $ 2,000,000 $ A - AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 34SBAIR0214 01/01/11 01/01/12 COMBINED SINGLE LIMIT accident) $ 1,000,000 BODILY INJURY BODILY NJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 34SBAIR0214 01/01/11 01/01112 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION $ 10,000 - $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERlEXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 1369942 01/01/11 01/01/12 STATU- OTH- T WC RY LIMIT ER E.L. EACH ACCIDENT - $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 q Property Section 34SBAIR0214 01/01/11 01/01/12 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Medical Provider P1089 If required by written contract or written agreement, the Certificate holder is included as Additional Insured for ongoing operations under General Liability. t.,tK I IFII�A I t r1ULUtK CANCELLATION City of Fort Collins Purchasing Division Louisa P 0 Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Z .BN LU.4.4�1, apny_ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD