HomeMy WebLinkAboutNORTH RANGE BEHAVIORAL HEALTH - INSURANCE CERTIFICATE (2)A ORb7 CERTIFICATE OF LIABILITY INSURANCE OPID DP ..........
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Rich S Cartmill Ins of CO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
of Colorado LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
8213 W. 20th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Greeley CO 80634
Phone: 970-356-8030 Fax: 970-356-8032 INSURERS AFFORDING COVERAGE NAIC # --
INSURED INSURERA: ACE American Ins Co 22667
North Range Behavioral Health
1300 N. 17th Avenue
Greeley CO 80631
rnvooer-rc
INSURER B: Pinnacol Assurance
INSURER C: Ace Property 6 Casualty
INSURER D: Westchester Fire Ins Co
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTRINSH NSR TYPE OF INSURANCE POLICY NUMBER DATECMM/DD/YYYY ATTE MMIDD/Y RATIONLIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
PREMISES(Eaoccurence)
$250,000
A
X
X COMMERCIAL GENERAL LIABILITY
SVRD37799361002
07/01/11
07/01/12
CLAIMS MADE OCCUR
MED EXP(My one person)
$10,000
PERSONAL BADVINJURY
$1,000,000
X Professional Liab
OGLG2550382AO02
07/01411
07/01/12
GENERAL AGGREGATE
$3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER'.
PRODUCTS - COMP/OP AGG
$3,000,000
Prof Liab
3,000,000
X POLICYJE° Loc
A
AUTOMOBILE
LIABILITY
ANY AUTO
CALHOS614611002
07/01/11
07/01/12
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON-OWNEDAUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY AGG
EXCESS I UMBRELLA LIABILITY
EACH OCCURRENCE
$2,000,000
C
X OCCUR CLAIMS MADE
XOOG25503740002
07/01/11
07/01/12
AGGREGATE
s2,000,000
$
DEDUCTIBLE
1 $
X RETENTION $ 10 , 000
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANVPROPRIETOR/PARTNDED? CUTIV4-7
OFFIC (Mandatory in NH) EXCLUDED? u
(Mandatory in NH)
4044331
07/01/11
07/01/12
X TORY LIMITS ER "
E.EEACH ACCIDENT
$100000
E.L. DISEASE -EA EMPLOYEE
$ 100000
E.L. DISEASE -POLICY LIMIT
_
j $ 5000 00
It yes describe under
SPECIAL PROVISIONS below
OTHER
D
Crime
CRMG25503788002
07/01/11
07/01/12
Crime $500,000
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of Fort Collins, Colorado, a Municipal Corporation, is listed as
additional insured as their interest may appear.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITFOR
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
City of Fort Collins, Colorado
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
A Municipal Corporation
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
300 LaPorte Ave
PO BOX 58O
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Michael J Schmitt CIC
Fort Collins CO 80522
ACORD 25 (2009101) S' Tsoo-tuuv AwUmu lwrtrvl(N I Ivry. HR ngnrs reserveu.
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