HomeMy WebLinkAboutCOLUMBINE MANAGEMENT SERVICES - INSURANCE CERTIFICATE (2)A� �® CERTIFICATE
OF LIABILITY INSURANCE
°A'�'M"�°e"Y'"'
6/30/2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
ONLY AND CONFERSNO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,
the terms and conditions of the policy, certain policies.may require
certificate holder in lieu of such endorsement(s)
the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
an endorsement. A statement on this certificate does not confer rights to the
PRODUCER
Professional Risk LLC
W:20th St
Greeley CO 80634
Y -.._
CONTACT NAME: Dionne Perez
. .. _ _
PHONE (970)356-803_0 FAX NO; (910)356-9039
NoExti-8213
_INC,
E-MAADDRESS:dionne.perez@proriskllc.com
.INSURERS AFFORDING COVERAGE
NAIC a
""
INSURER A: CARE INDUSTRY. LIABILITY RECIPROC
11832
INSURED Columbine Management Services; Columbine
Medical Equipment Inc.; Poucire Infusion Therapy
Front Range Theraphy Systems Inc.
802 W Drake Rd Ste 101
Fort Collins CO 80526
Inc;
INSURER B:
INSURERC:
INSURERD:
INSURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER:?0-21 Management REVISION NUMBER:
THISIS TO CERTIFY THAT THE -POLICIES OF INSURANCE LISTED BELOW HAVE BEENISSUEDTO 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
A
I I NSD
BR
WVT1
-
POLICY
I
NUMBER
POLICY EFF
M OrYYVY
- POLICY E%P
mp /YYYY
- - - -
LIMITS,. '
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE D OCCUR
,
.
DAMAGE -TO RENTED
PREMISES a Occurrence
$ -. _ _ 300, 000
X
MED. EXP (Any oneperson)
$ 5,000
PROFESSIONAL LIABILITY
X
,-
HRGC001o00
OC17
7/1/2020
7/1/2021
PERSONAL BADV-INJURY
$ _ 1,000,000
GEN'LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 3.,000,000
POLICY � PRO- .M. LOC
JE
PRODUCTS - COMP/OP AGG
S 9,000,000
Employee BerioN6
$ 1, 000, 000
OTHER.
AUTOMOBILE LIABILITY
COMBINED SINGLE-.LIMI
Ea ac Ident
$
BODILY INJURY (Par Person)
$
ANYAUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
y - -
- NONOWNED
HIREDAUTOS AUTOS
S ...
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
.S-
AGGREGATE
S.
E%LESS LUIB
CLAIMS -MADE
DED. RETENTION S
$
-
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
-
.
PER LITE OTH-ER
S AT ER
.
ANY PROPRIETOR/PARTNER/EXECUTIVE
.NIA
E.L. EACH ACCIDENT
.S _.
OFFICER)MEMBER EXCLUDED? a
(Mandatory in NH)
E(L. DISEASE -. EA EMPLOYEE.
$
It yei, describe undef
DESCRIPTION OF OPERATIONS below
E.L. DISEASE-. POLICY LIMIT -
,$
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additions Remarks
The City of Fort Collins, a Municipal Corporation
Schedule, may be attached B more space Is required)
is listed as additional insured as pertains to the
General Liability policy, per written contract.
.CERTIFICATE HOLDER I CANCELLATION
The City of Fort Collins, a Municipal
Corporation
Attn: Bob Adams, Director of Purchasi
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.
Perez/DP--s+--.aio�t-„c
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 (201401)