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Home My WebLink AboutCOLUMBINE MANAGEMENT SERVICES/ COLUMBINE HEALTH - INSURANCE CERTIFICATECOLUM•8 OP ID: DP , lls. O CERTIFICATE OF LIABILITY INSURANCE �.� DATUM/2ATE Y4 12119/2014 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 & Cartmill Ins of CO of Colorado LLC 8213 W. 20th Street Greeley, CO 80634 Michael J Schmitt CIC CONTACT NAME: Michael J Schmitt CIC PHONE 970-356-8030 FAX IAIC No Ea0- (A/c, No): 970-356-8032 E-MAIL ADDRESS: INSURER 5 AFFORDING COVERAGE NAIC or INSURER A: Health Cap RRG INSURED Columbine Management Services Inc 947 Worthington Circle Fort Collins, CO 80526 INSURER B: Hartford Fire Ins Co 19682 INSURER C: Midwest Employers Casualty Co 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. IR TYPE OF INSURANCE ADDEXP SUB POLICY NUMBER MMIDDPOUCYIYYYY MM�pOICY IYYYY LIMITS LTRINSIR LT GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X HRG-0001-0001.00-11 07I01I2014 07101/201$ -DAMAGE-TO-RENTED- PREMISES(Eis omurronce)_ $ 100,00 CLAIMS -MADE OCCUR MED EXP (Any one person) E S,DD PERSONAL B ADV INJURY $ 1,000,00 X Professional Liab GENERAL AGGREGATE $ 3,000,00 G 1 AGGREGATE LIMIT APPLIES PER-. PRODUCTS - COMPIOP AGG $ Included Emp Ben. $ 1,000,00 POLICY PRO X LOG JECTAUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) _$ 1,000,00 BODILY INJURY( Pe,person) $ B X ANY AUTO 34UUNVT1773 07101/2014 07/01/2015 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE (PER ACCIDENT $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE E EXCESS LIAB CLAIMS -MADE DID RETENTION$ $ C WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA EWC008902 0110112015 01101/2017 WC STATU- X OTM- TORYLIMITS -ER EL EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 EI DISEASE -POLICY LIMIT $ 1,000,08 If yes. describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Adach ACORD 101. Additional Romania Schedule, if more space Is required) Certificate holder: The City of Fort Collins, a Municipal Corporation, Attn: Bob Adams, Director of Purchasing and Risk Management ***See Notes*** CITFOR The City of Fort Collins (see above) c/o Purchasing Department 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 Michael J Schmitt CIC V I eCO-ZUIV AGVnU L.UIQ'UIKA I IUN. All rlgns resnrvuu. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD No Text