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Home My WebLink About446619 NORTH RANGE BEHAVIORAL HEALTH - INSURANCE CERTIFICATE (4)NORTH12 OF ID: DP A164 o CERTIFICATE OF LIABILITY INSURANCE D07/01ATE /2014 ) a7/ov2ota 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 Rich & Cartmiil Ins of CO _ of Colorado LLC 8213 W. 20th Street - GreelMichel CO Schmitt Michael J Schmitt CIC NA MTE CT Michael J Schmitt CIC PHONE g70-356$030 ac No,: 970-356-8032 A/c No Eat E.MAIL - ADDRESS: INSURERS AFFORDING COVERAGE NAIC e INSURER A:Philadelphia lnsuranceCo 23850 INSURED North Range Behavioral Health INSURER B: Pinnacol Assurance 1300 N 17th Avenue Greeley, CO 80631 INSURERC: Lloyds of London 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 POLICY NUMBER MADDL OL POLICY EFF MM/DDYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES Eooccurrence $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X PHPK1200226 07/01/2014 07/01/2015 CLAIMS -MADE Fx—] OCCUR MED UP (Any one person) $ 20,00 PERSONAL$ ADV INJURY $ 1,000,00 X Professional Liab X HIPAA Ind GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $ 3,000,00 Emp Ben. $ 1,000,00 POLICY PRO X LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ee am, ant 1,000,00 BODILY INJURY (Per person) $ A X ANY AUTO PHPK1200226 07/01/2014 07/01/2015 BODILY INJURY (Par accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE PERACCIDENT X UMBRELLA LIAB X OCCUR EACH OCCURRENCE AGGREGATE A EXCESS"ACLAIMS-MADE PHUB466313 07/01/2014 07/01/2015 DEDX RETENTION $10 000 E$2�',000,000 WORKERS COMPENSATION X WC STATU- OTH- IMIT B AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YI❑N OFFICERJMEMBER EXCLUDED?(Mandatory in NH) N/A 4044331 07/01/2014 07/01/2015 E.L. EACH ACCIDENT E.L. DISEA5E-EA EMPLOYEEIf E.L. DISEASE -POLICYLIMT yes, desail a underDESCRIPTION OF OPERATIONS he'. C Privacy UCS2669550.14 07/01/2014 07/01/2015 Each 1,000,00 Aggregate 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, AddlUonal Remarks Schedule, If more space Is required) City of Fort Collins, Colorado, a Municipal Corporation, is listed as additional insured as their interest may appear, per written contract. City of Fort Collins, Colorado A Municipal Corporation 300 LaPorte Ave PO Box 580 Fort Collins, CO 80522 CIT-FOR 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 Michael J Schmitt CIC ACORD 25 (2010/05) 1988-2010 The ACORD name and logo are registered marks of ACORD All rights reserved