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HomeMy WebLinkAbout378919 APS HEALTHCARE NORTHWEST INC - INSURANCE CERTIFICATE►coRo� CERTIFICATE OF PROPERTY INSURANCE `�- O06/30 2011YY) O6/30/2011 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 S Co. Insurance Brokers of California, Inc. License #0726293 CONTACT Robin Johnston PHONE FAX . 818-539-1354 ,. N0, 818-539-1654 E-MAIL Robin Johnston@ajg.com ADDRESS: 3g 505 North Brand Boulevard, Suite 600 PRODUCER Glendale, CA 91203-3944 CUSTOMER ID; INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: Great Northern Ins CO 20303 INSURER B: APB Healthcare, Inc. APB Healthcare Northwest, Inc. Attn: Debbie Payne INSURERC: INSURER D: 21 Governors Ct. Suite 210 INSURER E: Windsor Mill, MD 21244 INSURER F: COVERAGES CERTIFICATE NUMBER' ZZU9/290 REVISION NUMBER' LOCATION OF PREMISES I DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, it more apace la 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 I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYYYI') POLICY EXPIRATION DATE(MWDDNYYY) 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 S PP No Coinsurance $ CAUSES $ BASIC BUILDING X $ 4,800,000 BROAD $ CONTENTS X SPECIAL $ EARTHQUAKE Ix $ WIND IX $ 7,287,260 FLOOD $ $ X Replacement E INLAND MARINE CAUSES OF LOSS NAMED PERILS TYPE OF POLICY $ POLICY NUMBER $ $ CRIME TYPE OF POLICY $ $ BOILER A MACHINERY/ EQUIPMENT BREAKDOWN $ SPECIAL CONDITIONS / OTHER COVERAGES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Evidence of Insurance only. LeI92lelaeltL'VDIC 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 441/1v� USA robiioh Td 1QQ5.2nn0 ACORII CORPr1RATIf1N All rinhfe romr„ad ACORD 24 (2009/09) The ACORD name and logo are registered marks of ACORD 22097298 3:4 A �® CERTIFICATE OF LIABILITY INSURANCE ATE D06/30/2011IDDIY O6/30 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 6 Co. PHONE FAX 818-539-1654 Insurance Brokers of California, Inc. License #0726293 -INC. No. .Ed):_818-539-1354 AIC No: E-MAIL Robin Johnston@a' ADDRESS: 3g.com 505 North Brand Boulevard, Suite 600 INSURERS AFFORDING COVERAGE NAIC0 Glendale, CA 91203-3944 INSURER A: Great Northern Ins Co 20303 INSURED INSURERB: FEDERAL INS CO 20281 APS Healthcare, Inc. INSURERC: WAUSAU UNDERWRITERS INS CO 26042 APE Healthcare Northwest, Inc. INSURER D: Attn: Debbie Payne 21 Governors Ct. Suite 210 Windsor Mill, MD 21244 INSURER E: INSURER F C[]VFIli 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. INSR LTR rypE OF INSURANCE ADD L SUER POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY UP MM/DD LIMITS A GENERAL LIABILITY 35809570 06/30/11 06/30/12 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE r5�] OCCUR A O RENTED PREMISES Ea acwrrence $ 1,000,000 MED UP (Any one person) $ 10,000 PERSONAL B ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREIG�ATIE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ Included POLICY PRO- LOC JECTAUTOMOBILE $ LIABILITY COMBINED SINGLE LIMIT Ea acdtlent BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) S NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per eccitlent $ B X IUMBRELLALIAB X OCCUR 79842253 06/30/1i 05/30/12 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 E%CESS LIAR CLAIMS -MADE DED RETENTIONS $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNER]EXECUTIVE❑ WCJ-Z91-454866-011 06/30/1 06/30/12 X WC STATU- OTH- El EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASEEAEMPLOYE $ 1,000,000 (Mandatory In NH) f yes, tlescribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) ]The City or Fort Collins 19 add.d a5 Add1t10nal Insured for General L1an11ity On1V as resuects oncratIons OL the Named I 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. Attn: Purchasing Dept. P O Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 85022�.,{�y,�a�1'ri I USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD robijoh 22073347 3;a