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HomeMy WebLinkAboutDELTA DENTAL OF COLORADO - INSURANCE CERTIFICATEoRoCERTIFICATE OF LIABILITY INSURANCE DATE(MM•DD.'YYYY) 7 /23/2019 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 have ADDITIONAL INSURED provisions or 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). CONTACT PRODUCER NAME: IMA Denver Team IMA, Inc. - Colorado Division PHONE FAX 1705 17th Street, Suite 100 ! 303-534-4567 1AVC, No: Denver CO 80202 ADDRESS: DenAccountTechs(8_irnacorp.corn INSURED Delta Dental of Colorado Colorado Dental Service Inc. dba 4582 S. Ulster St., Suite 800 Denver CO 80237 DELTDEN to: Trumbull Insurance COVERAGES CERTIFICATE NUMBER:48661660 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. INSIR ADDl,SUBR: ..-._-____. __--____ __T_POLICY F.FF POLICY EXP LTR TYPE OFINSURANCE WVD. POLICYNULBER NND/YYYV 1 MWDYNY UWTS A X COMMERCIAL GENERAL LIABILITY 35775020 11/122018 1111212019 EACHOCCURRENCE $1.000.000 DAMAGE TO RENTED PI REMISE$ %curmmyl $1.000,000 CLAIMS MADE - X OCCUR MED EXP (Any oneperson) $10,000 PERSONAL 8 ADV INJURY S 1.000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 71 JERCOT ',LOC ICI PRODUCTS-COMP/OP AGO $INCLUDED $ OTHER: A AUTOMOBILEUABILrfY 1870207561 11/122018 11/12/2019 OMSIN DSINGLELIMIT L a_ac_cigentL $1.000,000 S ANY AUTO BODILY INJURY (Par portion) OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S PROPERTYDAMAGE S -- _ X AUIRFDTOS ONLY X AUTOSON-OWNED ONLY $ A X UMBRELLAUAB X OCCUR ^ 79790615 11/12/2018 11/12/2019 EACH OCCURRENCE 81.000.000 AGGREGATE $1,000,000 EXCESS UAB CLAIMS -MADE DEC X RETENTION n $ H WORKERS COMPENSATION 34WECI80856 AND EMPLOYERS- LIABILITY ANYPROPRIETORPARTNER'EXECUTIVE Y� 811/2019 811/2020 PE IX I ATUTE ER E.L. EACH ACCIDENT $500,000 CFPICER,MEMBEREXCLUDED4 N A (Mandatory In NH) _ $ 500_,000 E.L. DtSEASE - EA EMPLOYEE II yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY L0.11T $500.000 I DESCRIPTION OF OPERATIONS I LOCATIONS, VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required) City of Fort Collins is included as Additional Insured on the General and Automobile Liability Policies If required by written contract or agreement subject to the policy terms and conditions City of Fort Collins PO Box 580 Fort Collins CO 80522 USA GAIVGCLLA I IVIN 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (20161'03) The ACORD name and logo are registered marks of ACORD 2' of 2 823