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HomeMy WebLinkAboutCOLORADO PHYSICAL THERAPY SPECIALISTS PLLC - INSURANCE CERTIFICATE (2)ACC)R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) ��. 06/09/2015 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 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). PRODUCER ON NAME: NE JOHN C. BECKETT & ASSOCIATES, INC. (A/C, No, M: (970) 484-2805 (,/c, Ill.): (970) 484-2885 220 Smith Street E-MAIL tim@beckettinsurance.con Ft. Collings CO 80524- INSURMS) AFFORDING COVERAGE NAIL# INSURED INSURER A MARTFORD CASUALTY INS. CO. 29424 Colorado Physical Therapy Specialists PLLC INSURER S:PINNACOL ASSURANCE 210 W. Magnolia, Suite 110 INSURER c :PROASSURANCE SPECIALTY INS CO INSURER D ;ASPEN SPECIALTY INS CO INSURER E Fort Collins CO 80524- IINSURER F COVERAGES CERTIFICATE NUMBER: 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. INSIRTR ADDL POLICY EFF POLICY EXP POLICY EF FOLIC SWVD TYPE OF INSURANCE I LIMITS NSR POLICY NUMBER ( YYYY) A GENERAL LIABILITY 34SBhUI7263 6/04/2015 6/04/2016 EACH OCCURRENCE $ 2,000,000 AMAGE TO RENTED $OOOOO X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ MED EXP (Any one person) $ 10000 CLAIMS -MADE X OCCUR / / / / PERSONAL 8 ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS -COMP/OPAGG $ 4,000,000 _GENI 1 7 PRO - / / / / $ X POLICY LOC AUTOMOBILE LIABILITY NO COVERAGE / / / / COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS / / / / BODILY INJURY (Per person) $ BODILY INJURY (Per accident) -" $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS / / / / (Per accident) NON -OWNED AUTOS / / / / $ $ UMBRELLA LIAB OCCUR NO COVERAGE / / / / EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE / / / / AGGREGATE _ $ / / / / —_ DEDUCTIBLE $ RETENTION $ / / / / _ $ B WORKERS COMPENSATION 4136145 ',12/01/2014 12/01/2015 WC STATU- OTH- X TOR-Y LIMITS_ AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT --- --- ANV PROPRIETOR/PARTNER/EXECUTIVE / / / / $ 100,000 - OF EXCLUDED? NIA / / / / (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 100 000 If yes, describe under / / / / - -- - _ DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 C PROFESSIONAL LIABILITY AFC9266914 0/11/2014 10/11/2015 PER OCCURRENCE 1,000,000 D PRIVACY LIABILITY tP78203 7/05/2014 07/05/2015 AGGREGATE PROFESSIONAL 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) CERTIFICATE HOLDER IS AN ADDITIONAL INSURED PER WRITTEN CONTRACT ON THE GENERAL LIABILITY FOR THE ONGOING OPERATIONS OF THE INSURED. CERTIFICATE HOLDER CANCELLATION (970) 221-6775 CITY OF FORT COLLINS ACCOUNTING DEPARTMENT PO BOX 580 FORT COLLINS CO 80522-0580 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 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD