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HomeMy WebLinkAbout200149 POUDRE VALLEY HEALTH CARE INC - INSURANCE CERTIFICATE. l'.� R ' CERTIFICATE OF LIABILITY INSURANCE `3 730/D/30//DD/Y2013 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 endorsements . PRODUCER Beecher Carlson Insurance Services, LLC 321 North Clark Street 5th Floor Chicago IL 60654 4 CONTACT R1ZZ MOraldo NAME: Y PHONE 401-369-8247 FAc o:401-369-e241 EMAIL .kmoraldo@beechercarlson.com INSURERS AFFORDING COVERAGE NAIC It INSURERA:CO is Companies 11860 INSURED POudre Valley Health Care, Inc. dba Poudre Valley Health System 2127 E. Harmony Rd. Suite 200 Fort Collins CO 80528 INSURERB:Travelers Insurance Company INSURERC: INSURER D: INSURERE: INSURERF: CUVtKAUtJ CERTIFICATE NLIMRER'CL1J52J2789B RFVIRInw NIIMRFR• 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 DDL INSR SUBRI POLICY NUMBER POLICY EFF MM/DDIYYYY) POLICY EXP JMM/DDffYYYI LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY _x1 RCCO008522 /1/2013 /1/2014 DAMA E T R N D PREMISES Ea occurrence S 500,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE F_x1 OCCUR PERSONAL B ADV INJURY $ 1,000,000 X Malpractice Liability GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 X POLICY PRO X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea amtlent BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS ( BODILY INJURY Per accident) $ HIREDAUTOS NON -OWNED AUTOS J PROPERTY DAMAGE Per accident $ $ X I UMBRELLA LIAR X OCCUR CC0009293 /1/2013 /1/2014 EACH OCCURRENCE $ 15,000,000 X AGGREGATE $ 15,000,000 EXCESS LIAB CLAIMS -MADE DED ' RETENTION$ 1 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A TC21KUB-1761B96-3-12 0/1/2012 0/1/2013 X 01 STATU- OTH- FIR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) I(yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 1f more space is required) Workers Compensation limits are Aggregate $13,774,000. Also include: Director & Officers Liability G25752168001 e££ 7/1/2014 Ace Insurance Co limit $15,000,000 City of Fort Collins PO 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 Dodero/KIZZY J'aIM4 e A.%oY(i.. AGUKU 25 (ZUIU/U5) INS025 (2010(35).01 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD