The URL can be used to link to this page

Home My WebLink AboutSUMMITSTONE HEALTH PARTNERS - INSURANCE CERTIFICATE (2)A� R ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/8/2019 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 SUBROGAT)ON 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 8213 W.20th St Greeley CO 80634 CONTACT NAME: Jennifer Hunter PAIC. Ne at: (970)356-8030 FAX No:(970)356-a032 E-MAIL ennifer.hunter@proriskllc.com ADDRESS: -- INSURERS) AFFORDING COVERAGE NAIC a INSURERA:Philadelphia Insurance Cc 18058 INSURED SummitStone Health Partners 4856 Innovation Drive, Suite B Fort Collins CO 80525 INSURERS: Pinnacol Assurance 41190 INSURER C: Travelers Casualty s Surety Company of 31194 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:19-20 HIPPA 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 MAYBE 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 ADDLISUBRI POLICY NUMBER MWDDY BEE IYYYY POUCYEXP MWDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A CLAIMS -MADE X OCCUR DAMAGE PREMISES Ea ttrranceii E 100,000 X MED EXP(Any one person) $ 5,000 Professional Liability X PHPK2003065 7/1/2019 7/1/2020 PERSONAL 8 ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 POLICY O PRO. D LOC JECT PRODUCTS - COMP/OP AGG $ 3,000, 000 Employee Benefits $ 1,000,000 OTHER AUTOMOBILE LIABILITY Ea COMBINEnt I L LIMIT $ 1,000,000 BODILY INJURY (Par person) $ A %t ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS X PHPK2003065 7/1/2019 7/1/2020 BODILY INJURY (Per accident) E PROPERTY DAMAGE Per accid nl $ E UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE E EXCESS LWB CLAIMS -MADE DIED I I RETENTION S $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE O OFFICERIMEMBER EXCLUDED? (Mandatory In NH) NIA 4044330 7/1/2019 7/1/2020 X I PER O H- STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE $ 100,000 EL DISEASE -POLICY LIMIT $ 500,000 It yes describe untler DESCRIPTION OF OPERATIONS belay C Privacy 106545865 7/1/2019 7/1/2020 Aggregate $ 2,000,000 A HIPPA PHSD1459940 7/1/2019 7/1/2020 HIPPA Lime $ 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, AddRional Remarks Schedule, may be attached it more space Is required) 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 onne Perez/DP •---A�*�'<-R--�- ACORD 25 (2014/01) INS025 ci4c1 The ACORD name and logo are registered marks of ACORD