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Home My WebLink About129656 DELTA DENTAL OF COLORADO - INSURANCE CERTIFICATEClient#: 27670 DELTDEN ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE 10/7/2007/20/Y4 1 14 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(les) 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 CONTACT NAME: IMA, Inc. -Colorado Division AICON oEat: 303-534-4567 FAX (A/C No: 303-534-0600 1705 17th Street, Suite 100 E-MAIL deam//��aco ADDRESS: n P VImr pcom Denver, CO 80202 INSURER(S)AFFORDING COVERAGE NAICM 303-534-4567 INSURER A: Federal Insurance Co. (Chubb) 20281 INSURED INSURERB: Plnnacol Assurance 41190 Delta Dental of Colorado Colorado Dental Service Inc. dba INSURER C : 4582 S. Ulster St., Suite 800 INSURER D : Denver, CO 80237 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 ADDLSUB INSR Me POLICYNUMBER POLICY EFF MM/DD/YY POLICY EXP MM/DDNYY1' LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F7x OCCUR 35775020 _ 1/12/2013 1111212014 EACH OCCURRENCE $1000000 PREMISES ERENTED nce $1 00O 000 MED EXP (Any one person) $1 O 000 PERSONAL B ADV INJURY $1 00O 000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PER: PRO- JECT LOC PRODUCTS-COMPIOP AGO $Included $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 70207861 11/12/2013 11/121201 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ X PROPER DAMAGE Per accident $ A X UMBRELLA EXCESS DAB J( OCCUR CLAIMS -MADE 79790815 1/12/2013 11/12/2014 EACH OCCURRENCE $1000000 AGGREGATE $1 00O 000 DELI I X I RETENTION$0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? 51 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 906672 6/O1/2014 06/O1/2O1 X WCSTATU- OTH- TO Y11M'TS E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE - POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract or agreement subject to the policy terms and conditions. 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 ACORD 25 (2010105) 1 of 1 #S1071801/M1049805 U 19HU-201U AGORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NEJ