Loading...
HomeMy WebLinkAboutCENTER FOR NEUROREHABILITATION SERVICES P.C. - INSURANCE CERTIFICATEACORD© CERTIFICATE OF LIABILITY INSURANCE DATE (MMIY) 4/30/2015015 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 Ewing -Leavitt Insurance Agency 4025 St. Cloud Dr. Suite 100 Loveland CO 80538 CONTACT Karole Peters NAME: PHONE . (970)679-7355 FAXN (866)237-2178 E-MAIL .karole-peters@leavitt.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Foremost Insurance Company 11185 INSURED Center for Neurorehabilitation Services P. C. 1045 Robertson Street Fort Collins CO 80524 INSURER B:Columbia Insurance Company 7812 INSURERC:Pinnacol Assurance 41190 INSURERDAdmlral Insurance Company 4856 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 PL Update 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 ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD YYY LIMITS GENERAL LIABILITY PAS 05078854 1/28/2015 1/28/2016 EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR DAMAGE TO REN D PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one Derson) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 nGEN'L X POLICY PRO- LOC $ AUTOMOBILE LIABILITY 71APR314921 1/28/2015 1/28/2016 COMBINEDSINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS Medical pavirrents $ X 4OCCUR UMBRELLA LIAB X AS 05078854 1/28/2015 1/28/2016 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE DED X 7RETENTION$ 10,00 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N / A 4127541 11/1/2014 1/1/2015 X WC STATU- I OTH- ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 D Professional Liability 0000006704-09 5/1/2015 /1/2016 Limit per claim/$2,500 ded $1,000,000 Aggregate $ 3, 0 0 0, 0 0 0 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Professional Liability: Named Insured includes Mary Jackson PT and Jacqueline McGough PT and any principal, partner, officer, director, employee, volunteer worker while acting within the scope of his duties as such for Center for Neurorehabilitation Services PC. l9yC�\Ir P)G\\ y�Pl�9ti1 City of Fort Collins, EPIC P.O. 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 Peters/KAPETE 0A<.0-ail ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (zo1oo5) of The ACORD name and logo are registered marks of ACORD