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HomeMy WebLinkAboutCOLUMBINE HEALTH SYSTEMS - INSURANCE CERTIFICATE (3)A � CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/27/2019 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 CONTACT NAME: Jennifer Hunter PHNEProfessional o EXt: (970)356-8030 A/C NO: I9701356-6032 A/CD No, Risk LLC E-MAIL ADDRESS: Jennifer.hunter@proriskllc.com 8213 W.20th St INSURERS AFFORDING COVERAGE NAIC p INSURERA:HEALTH CARE INDUSTRY LIABILITY RECIPROC 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 W Drake Rd Ste 101 INSURER F: Fort Collins CO 80526 COVERAGES CERTIFICATE NUMBER:19-20 Management -All 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 CONTRACTOR 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 OF INSURANCE ADDLTYPE INSO WVDSUEIR POLICY NUMBER POLICY MM DD/YYYY MM /DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR PREMISES Ea o currrrence $ 100,000 X MED EXP (Any one person) $ 5,000 Professional Liability X HRG-CO01-0001-OC -16 7/1/2019 7/1/2020 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 3,000,000 POLICY PRO X LOC JECT PRODUCTS - COMP/OPAGG $ 3,000,000 Employee Benefits $ 1,000,000 OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X 1N979650 7/1/2019 7/1/2020 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIREDAUTOS AUTOS UMBRELLA LIAB EACH OCCURRENCE $ HOCCUR AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE STATUTE X OTRH- E.L. EACH ACCIDENT $ 1,000,000 E L DISEASE - EA EMPLOYEE $ 1,000,000 C OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) NIA A UDE093759619 1/1/2019 1/1/2020 E L. DISEASE - POLICY LIMIT $ 1,000,000 it yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: License C1-8. City of Fort Collins is listed as 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 Dionne Perez/DP ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD