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Home My WebLink AboutAPS HEALTHCARE INC - INSURANCE CERTIFICATE (2)1CO2I I �/- •l CERTIFICATE OF PROPERTY INSURANCE DATE (MMIDDNYYY) 06/30/2011 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. If this certificate is being prepared for a party who has an insurable interest in the property, do not use this form. Use ACORD 27 or ACORD 28. PRODUCER 1-818-539-2300 Arthur J. Gallagher 6 Co. Insurance Brokers of California, Inc. License #0726293 CONTACT Robin Johnston NAME:PHONE FAX Nw.Eai- 818-539-1354 ac No: 818-539-1654 EMAIL Robin Johnston@ajg.com AOOREss, J9 505 North Brand Boulevard, Suite 600 PRODUCER Glendale, CA 91203-3944 CUSTOMER ID:_ INSURERIS) AFFORDING COVERAGE NAICN INSURED INSURER A: Great Northern Ins Cc 20303 INSURER B: APB Healthcare, Inc. APB Healthcare Northwest, Inc- Attn: Debbie Payne INSURER C: INSURER D: 21 Governors Ct. Suite 210 INSURER E: Windsor Mill, M 21244 INSURER F : COVERAGES CERTIFICATE NUMBER: 22097298 REVISION NUMBER: LOCATION OF PREMISES I DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, if mom space is required) 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 POLICY NUMBER POLICY EFFECTIVE DATE(MWDDNYY17 POLICY EXPIRATION DATE(MMIDDIYYYY) COVERED PROPERTY LIMITS A X PROPERTY OF LOSS DEDUCTIBLES 35809570 06/30/11 06/30/12 BUILDING PERSONAL PROPERTY BUSINESS INCOME EXTRA EXPENSE RENTAL VALUE BLANKET BUILDING BLANKET PERS PROP BLANKET BLDG 4 PP No Coinsurance E CAUSES XI S BASIC BUILDING E 4,800, 000 BROAD E CONTENTS X SPECIAL X X E EARTHQUAKE E WIND $ 7,287,260 FLOOD E E x Replaceme E INLAND MARINE CAUSES OF LOSS NAMED PERILS TYPE OF POLICY E E POLICY NUMBER E E CRIME TYPE OF POLICY I I E E E _ BOILER 4 MACHINERY I EQUIPMENT BREAKDOWN I --II E E E SPECIAL CONDITIONS / OTHER COVERAGES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Evidence of Insurance only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Purchasing Dept. P O BOX 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 85022 664.V 14gv ' USA robijoh ACORD 24 (2009/09) @ 1995.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 22097298 3:4 ,aCtI CERTIFICATE OF LIABILITY INSURANCE FATE O06/30/20IDDI11 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. If SUBROGATION 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 1-818-539-2300 CONTACT NAME: Robin Johnston Arthur J. Gallagher S Co. PHONE FAX 818-539-1354INC. 818-539-1654 Insurance Brokers of California, Inc. License ii0726293 .(Nc. No,Eat: No): E-MAIL Robin Johnston@a' com ADDRESS: 3g 505 North Brand Boulevard, Suite 600 INSURERS AFFORDING COVERAGE NAICP Glendale, CA 91203-3944 INSURER A: Great Northern Ins Co 20303 INSURED INSURER B: FEDERAL INS CO 20281 APB Healthcare, Inc. INSURER C: WAUSAU UNDERWRITERS INS CO 26042 APB Healthcare Nort.hxest, Inc. INSURER D: Attn: Debbie Payne 21 Governors Ct. Suite 210 Windsor Mill, NO 21244 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 22073347 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. INSIRLIM LTR TYPE OF INSURANCE ADOLLSUBR POLICY NUMBER MMIOOY EFF IPMCDYEXP LIMITS A GENERAL UABILITY 35809570 06/30/1 06/30/12 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea cocurreacel $ 1,000,000 CLAIMS-MADEOCCUR MED EIP(My one person) $10,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ Included $ POLICY RO LOC F7 PECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTNON- PROPERTYDAMAGE Peraccident $ HIRED AUTOS AUTOS B X UMBRELLA LIAR X OCCUR 79842253 06/30/11 06/30/12 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMG-MADE DEO I I RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANV PROPRIETOR/PARTNEPIEXECUTIVE Y/❑N WCJ-291-454866-011 06/30/11 06/30/12 X we sTATu- oTH- EL FJCH ACCIDENT $ 1,000,000 OFFICERIMEMSER EXCLUDED] (Myandatory in NH) NIA EL DISEASE -FA EMPLOYE $ 1,000r000 DESCRIPTION OF OPERATIONS belox E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required) IThe Cltv of Fort Collins is Added as Aaditional Insured tor General Lianilit_v only as reenacts o_oerations or the Named 1 Insured. Subject to policy terms, conditions, limitations and exclusions. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. to: Purchasing Dept. O So. 580 AUTHORIZED REPRESENTATIVE Collins, CO 85022 I 44vlaNe '� I USA ACORD 25 (2010/05) robijoh 22073347 W 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 3:0