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Home My WebLink AboutCOLUMBINE HEALTH SYSTEMS - INSURANCE CERTIFICATET ® A� 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/10/2018 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 NAME: Jennifer Hunter PAHONN Ext. (970)356-8030 No): (910)356-8032 Professional Risk LLC E-MAIL jennifer.hunter@proriskllc.com ADDRESS: 8213 W.20th St INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:HEALTH CARE INDUSTRY LIABILITY RECIPRO( 11832 Greeley CO 80634 INSURED INSURER B: Travelers Property Casualty Ins Co 36161 _ INSURERC:State National Insurance Columbine Management Services, Inc. dba Columbine INSURER D: Health Systems _ INSURERE: 802 West Drake Road, Suite 101 INSURERF: Fort Collins CO 80526 Cr)VFRAr;FS CFRTIFICATF NUMBFRI1:1-19 Mgmt-All/1-9-ZU WC REVISION NUMBLK: 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 INSD UBR WVD POLICY NUMBER POLICY EFF MMI D/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE FxI OCCUR DAMAGE TO ITED PREMISES Ea occurrence $ 100,000 X MED EXP (Any one person) $ 5,000 Professional Liability X BRG-CO01-0001-OC-15 7/1/2018 7/1/2019 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 3,000,000 POLICY JE O- M LOC Employee Benefits $ 1,000,000 OTHER AUTOMOBILE LIABILITY MBINED SIN LE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS X aA5E978078 7/1/2018 7/1/2019 BODILY INJURY (Per accident) $ PROPERTDAMAGE raccident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED?tiDE093759619 (Mandatory in NH) N/A 1/1/2019 1/1/2020 1 PER STATUTE X ORH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 I/ yes describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: License C1-8. City of Fort Collins is listed s additional insured as pertains to the General and Auto Liability policies, per written contract. CERTIFICATE HOLDER CANCELLATION 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 onne Perez/DP U 19BB-2014 ACORD GURNUKA I IUN. All ngnts reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401,