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HomeMy WebLinkAbout446619 NORTH RANGE BEHAVIORAL HEALTH - INSURANCE CERTIFICATE (7)NORTH12 OP ID: DP ACORO 7OT6/24/2015 E (MM/DDYYYY) CERTIFICATE OF LIABILITY INSURANCE E(MMID fYY 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 NAME: CONTACT J Schmitt CIC_ Rich & Cartmlll Ins of CO PHONE FAX of Colorado LLC /c ANg E>R):970-356-8030 (A/C, No): 970-356-8032 8213 W. 20th Street E-MAIL ADDRESS: Greeley, CO 80634 - ---- -- Michael J Schmitt CIC __ INSURERS AFFORDING COVERAGE NAIC N _ INSURER A: Philadelphia Insurance Co 23850 -- ---- ---- INSURED North Range Behavioral Health INSURER B : Pinnacol Assurance 1300 N 17th Avenue -- Greeley, CO 80631 INSURER c :Lloyds of London INSURER D : I INSURER F : I I rnvcDnnGe r`FRTICIr'ATF Nit IlU1I RFVI.RInN NI IMRFR- T"HIS 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. ICY EXP INSR TYPE OF INSURANCE ADDL SUER _ POLICY NUMBER MM/DD YYYY MMLDD YYYY LIMITS LT RWVD A 1 X 1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE OCCUR X PHPK1356673 07/01/2015 07/01/2016 DAMAGE TO RENTFU_ PREMISES Eaoccu ence $ 1,000,00 MED EXP (Any one person) $ 20,00 X Professional Liab PERSONAL & ADV INJURY $ 1,000,00 X HIPAA incl GENERAL AGGREGATE $ 3,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,00 POLICY 1-1PRO- JECT LOC lEmp Ben. $ 1,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1000000 ,, A X ANY AUTO PHPK1356673 07/01/2015 07/01/2016 BODILY INJURY (Per person) $ ` AALL UTOS OWNED SCHEDULED AUTOS NON -OWNED HIRED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident —_ $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,_0_0 A EXCESS LIAB CLAIMS -MADE PHUB604760 07/01/2015 07/01/2016 $ DED I� X 1 RETENTION $ 10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED I (Mandatory in NH) N / 0` 4044331 07/01/2016 07/01/2016 X STAT TE ER H E.L. EACH ACCIDENT _ $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 i If yes, aesercue under , DESCRIPTION OF OPERATIONS below _ C 'Privacy UCS2669550.15 07/01/2015 07/01/2016 Each 1,000,00 Aggregate 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins, Colorado, a Municipal Corporation, is listed as additional insured as their interest may appear, per written contract. CERTIFICATE HOLDER UANUtLLAI IUN CIT-FOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins, Colorado ACCORDANCE WITH THE POLICY PROVISIONS. A Municipal Corporation 300 LaPorte Ave AUTHORIZED REPRESENTATIVE PO Box 580 Michael J Schmitt CIC Fort Collins, CO 80522 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD