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HomeMy WebLinkAboutCOLUMBINE HEALTH SYSTEMS - INSURANCE CERTIFICATE (4)76127/2019 (MMIDD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE Ill 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 pc icy(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 CO TACT NAME: Jennifer Hunter Professional Risk LLC ONE. (970)356-6032A()/Cac Ext: NU: 8213 W.20th St E-MAIL jennifer.hunter@proriskllc.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Greeley CO 80634 INSURERA:HEALTH CARE INDUSTRY LIABILITY RECIPROC 11832 INSURED INSURER B:Travelers Property Casualty Ins Co 36161 Columbine Management Services, Inc. dba Columbine INSURERC:State National Insurance Health Systems INSURER D: 802 W Drake Rd Ste 101 INSURER E: Fort Collins CO 80526 INSURER F: 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 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 N SUBR W POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE a OCCUR DAMAGE PREMISES TOEa o currrrence $ 100,000 X MED EXP (Any one person) $ 5,000 Professional Liability X HRG-0001-0001-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 F—IJECT PRO LOC PRODUCTS - COMPIOPAGG $ 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 ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS 1N979650 7/1/2019 7/1/2020 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLALIA13 OCCUR EACH OCCURRENCE $ AGGREGATE $ LIAR CLAIMS -MADE []�EXCESS DED RETENTION S $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER STATUTE X OTRH- E.L. EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA NDE093759619 1/1/2019 1/1/2020 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS / LOCATIONS I 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)