HomeMy WebLinkAbout543224 SUMMITSTONE HEALTH PARTNERS - INSURANCE CERTIFICATEAli D CERTIFICATE OF LIABILITY INSURANCE
DATE,MMlD°nrYn
7/2/2020
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
REPRESENTATIVEOR.PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(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 end,orsement(s).
PRODUCER
Professional Risk LLC
8213 W.20th St
Greele - - CO `80634
Y
VVIN NAME: Dionne Perez
PHONE (970)356-803D - FAX (970)356-e032
AIC No):
ADDRESS: dionne. Perez@Prori Skllc. com
INSURERS AFFORDING COVERAGE
NAIC d
INsuRERA:Philadel'his Insurance Co.
18058
INSURED
SummitStone Health Partners
4856 .Innovation Drive, 'Suite B
Fort Collins CO BQ525
INSURER B: Pinnacol Assurance
524210
INSURER C:Travelers CasualIt S Surety Company of
31194
INSURER D:.
INSURER E :
INSURER F:
.COVERAGES CERTIFICATE NUMBER:20-21 HIPPA REVISION` NUMBER:
-
THIS ISTO CERTIFY THAT THE POLICIEPOLICIES INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THEPOLICYPERIOD
_
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT. WITH RESPECT TO WHICH THIS- -
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBAdTTO ALL THE TERMS, -
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED_BY.PAID CLAIMS._.
INSR
LTR
.A
TYPE OF INSURANCE
-. `... ... ._
POLICY NUMBER
POLICYEFF.
MMIDDIYYYY -
POLICY E7(P.
MMIDorfM.
- -LIMITS -.
X
COMMERCIAL GENERAL ABILITY"
.EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE F 7xOCCUR -
-
-77
DAMAGE TO RENTED
PREMISES- Ea. occurrence
$ 100,000
MED.EXP(Any one.person)
E._ _ _-_5,000
'
X
PHPK2151926
7/1/2020
7/1/2021
PERSONAL. B ADV INJURY
E 1,000,000
GENIAGGREGATE LIMITAPPLIES. PER.
.GENERAL AGGREGATE
$ 3,000,000
PRODUCTS - COMP/OP AGG
$ 3,000,, 000
O.
POLICY a PRO- JECTQ LOC
Employee Benefi%
-- -
7-7
$ 1 , 000 1,000
OTHER:
AUTOMOBILE LIABILITY
Ea acddent COMBINED SINGLE III
E 1 000 , 000
BODILY INJURY (Per person)
_
E
A
%{ ANYAUTO
ALL OWNED SCHEDULED
AUTOSx
AUTOS NON -OWNED
HIREDAUT( AUTOS
PHPK2151926
7/1/2020
7/1/2021
BODILY INJURY (Per accident)
-
$
TY DAMAGE
Per accident)
S
UMBRELLA LAB
OCCUR
EACH QCCVRRENCE
$
..
. ..
AGGREGATE
.
$
EXCESS LIAS
CLAIMS -MADE
-
DED ._ " RETENTION_E
..
.B
WORKERS COMPENSATION _ - ..
AND EMPLOYERS' LUIBILITY, _
.. ..YIN.
ANV PROPRIETOR/PARTNER/EXECUTIVE"
OFFICER/MEMBER EXCLUDED? Y
(Mandatory In NH)
,:
NIA
- -
604433.0
7/1/2020,
7/1/2021
X PER T -
7 T TE R
_.
.E.LEACH ACCIDENT
$100,006
'
-E.L_DISEASE -.EA EMPLOYEE
S 100,000
E.L. DISEASE -POLICY LIMIT
$ 506,000
it yes, descnbe under --
DESCRIPTION OFOPERATIONSbelow
_
C
"PRIVACY
306545865
-7/1/2020'
7/1/2021
AGGREGATE .- .$' 2,000,000
-A
HIPPA
PBSD15i87557/1/2020
7/1/2021
HIPPA LIMIT $ 50,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addldonal Remarks Schedule, may be attached K 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.
City of Fort Collins
PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POUCIEs BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE'WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
REPRESENTATIVE
onne Perez/DP+.►to<-.cO
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)