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Home My WebLink AboutCOLUMBINE HEALTH SYSTEMS - INSURANCE CERTIFICATE (2)n`oCERTIFICATE OF LIABILITY INSURANCE DATE(M/2018 12/10/2018�R" 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 Professional Risk LLC 6213 W.20th St Greeley CO 80634 NAME: Jennifer Hunter AHCNNo Ezt): (970) 356-8030 FAX N0: (970)356-6032 E-MAIL jennifer.hunter@proriskllc.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: HEALTH CARE INDUSTRY LIABILITY RECIPRO( 11832 INSURED Columbine Management Services, Inc. dba Columbine Health Systems 802 West Drake Road, Suite 101 Fort Collins CO 80526 INSURER B:Travelers Property Casualty Ins Co 36161 INSURERC:State National Insurance INSURER D: INSURER E: INSURER F: COVFRAGFS CERTIFICATE NUMBER:18-19 Mgmt-All/19-20 WC 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 I DL INSD WV POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DDffYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE XOCCUR DAMAGE TO RENTE15 PREMISES Ea occurrence $ 100 , 000 X MED EXP (Any one person) $ 5,000 Professional Liability X HRG-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 O- POLICYE PET F�J LOC Employee Benefits $ 1,000,000 OTHER. AUTOMOBILE LIABILITY COMBINED 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 BASE 978078 7/1/2018 7/1/2019 BODILY INJURY (Per accident) $ PPReOPPER nDAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ Id AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERJEXECUTIVE STATUTE X ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 C OFFICER/MEMBER EXCLUDED? (Mandatory in NH) � N/A NDE093759619 1/1/2019 1/1/2020 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 If yes, describe under UESCRIPT16N OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins, a Municipal Corporation is listed as additional insured as pertains to the General Liability policy, per written contract. CERTIFICATE HOLDER CANCELLATION The City of Fort Collins, a Municipal Corporation Attn: Bob Adams, Director of Purchasing and Risk Management PO Box 580 FortlCollins, 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 Cc) 198R-2014 ACORD CORPORATION- All riahts reserved. ACORD 25 (2014101) Tha ACORD name and logo are registered marks of ACORD INS025 (201401)