HomeMy WebLinkAboutCOLUMBINE HEALTH SYSTEMS - INSURANCE CERTIFICATE (5)ACC>Ra (MMtDDNYYY)'
CERTIFICATE OF LIABILITY INSURANCE
76,30/2020
THIS CERTIFICATE IS ISSUED AS A MATTEROFINFORMATION ONLY AND'CONIFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY A MEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE IASUINGINSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE OLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) rriLfst be ah-clankid. If SUBROGATION -IS WAIVED, sboje-dFiT
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not Confer rights to the
Professional Risk LLC
8 21 3 w. 2 Oth St
6-
Skl-1 a : com
Columbine Management Services, DBA: Columbine -INSURERC.;-
Health Systems INSURER D:-
4802 W Drake Rd Ste 101, INSURERE;
Fort Collins CO 80526 I1NSURERF.:__
rf.N I %1W0Ar_'= r1F:PTI9:IrATF; hilIMIRFR-120-21 Management REVISION NUMBER!.
THIS IS TO CERTIFY THAT THE.POLICIES OF INSURANCE LISTED BELOW
INDICATED. 'NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION
C ERtIFjcATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN
HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD -
OF ANY CONTRACT OR.OTHER DOCUMENT WITH RESPECT TO WHICH THIS
BY THE'POLICIESr DESCRIBED HEREIN ISSUBJECT TO ALLTHE TERMS,
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
AUULjbUIJKj
PC
UCY NUMBER
IMMIDDNYYY�
POLICY EXP'
IMMfDDfYYYYI
_._LIMITS'
A
X
COMMERCIAL GENEIiAl. LIABILITY'
CLAIMS -MADE OCCUR
FX7
PROFESSIONAL LIABILITY
X
HR0000,1.0001OC17
7/11/2020
7/1/2021.
EACH OCCURRENCE.
A, 9P0, 000
.7
DAMAQEJO RENTED
PREMISES (Ea occurrence)
$ 10 1 0,00 1 0
_X
ME6.EXP (My one Person)
$ 5,000
PERSO N AL &ADV INJUR Y
GEN'LAGGREGATE LIMITAPPLIES PER,
OLICY D PROCT LOC
P JE
OTHER.
GENERALAG - GREGATE
$ 3,990,000
PRODUC TS-COMP/OPAGG
$ 3 000,000
Ernployee Benasts
$
Aut6mosii.E LIABILITY
ANY AUTO
ALL OWNED F --- I SCHEDULED
AUTOS NVOTOWNED
HIRED AUTOS AUTOS
COMBINED SIMILE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BbbiLy INJURY (Per accide accident)
PROPERTY DAMAGE
(Por accident)
UMBRELLA LINE
EXCESSIUAS,
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
7
. DED—F I RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY' Y/N
ANY PROPRIETORIPARTNER/EXECUTIVE -
OFFICER/MEMBER EXCLUDED?
(Mandatory in -NH)
yes. describe undo
DESCRIPTION OF OPERATIONS ealow-
N/A
[PEARTUtE_ ITH-
ST ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - LA EMPLOYEEIf
E.L. DISEASE - POLICY LIMIT
7—
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Re
The City of Fort Collins, a Municipal Corporation
General Liability policy, per written -contract.
rice Schedule, my be attached If more space Is mcikilred)
is listed as additional insured as pertains to the
CERTIFICATE HOLDER IL;ANL;1zLLAIIL)N
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCE1LLIfD BEIFQRE
The City of Fort Collins, a Municipal THE.FXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Corporation
Attn: Bob Adams, Director of Purchasirg
AUTHORIZED REPRESENTATIVE
and Risk Managefrivant
PO FortBox 580 ns, CO 80522 Dionne Perez/DP
l Colli
&1988-2014-ACO.RD-CORPORAT.ION.. All. rights reserved.
ACORD 25 (261401) The ACORD narn and logo are registered mairks of ACORD
INS025 (201401)