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HomeMy WebLinkAboutCOLUMBINE MANAGEMENT SERVICES/ COLUMBINE HEALTH - INSURANCE CERTIFICATE (2)COLLIM-8 OP ID: DP ACORO YY) 7OT6/26/2015 �,�CERTIFICATE OF LIABILITY INSURANCE E (MM/DD/YYD/YY 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 CONTNAME: Michael J Schmitt CIC Rich & Cartmill Ins of CO PHONE FAX of Colorado LLC ac No EXt1:970-356-8030 Luc No): 56 970-3-8032 8213 W. 20th Street E-MAIL i _----- _ Greeley, CO 80634 ADDRESS: - --- Michael J Schmitt CIC _-_ INSURERMAFFOROING COVERAGE _- NAIC N INSURER A; Health Cap RRG INSURED Columbine Management Services INSURER B: Travelers Prop Casualty 25674 Inc. -------------_-----. _ INSURER CEmployers 802 West Drake Road, Suite 101 _:Midwest Em ters Casual Co - —_ ------ - - —- Y---- -- —- Fort Collins, CO 80526 INSURERD: INSURER E : INSURER F C[1VFRArFS CFRTIFICATF NI IMRFR• REVISION NUMRFR! 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. INSRT ADDL SUB POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 X1 + CLAIMS -MADE 1 IOCCUR X HRG-CO01-0001-OC-12 07/01/2015 07/01/2016 DAMAGE f5 RENTED PREMISES (Eaoccurrance) - $ 100,00 ME EXP (Any one person) $ 5,00 X Professional Liab PERSONAL & ADV INJURY $ 1,000,00 GATE LIMIT APPLIES PER. G, NT AGGREGA_ GENERAL AGGREGATE $_ 3r_000,00 PRO- l RE` L X l LOC PICY I_ OL_ P PRODUCTS COMPIOP AG _ $ InClUded _---- -- _ Emp Ben. OTHER $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accidang $ 1 000 00 _--.-__! _--! BODILY INJURY (Per person) $ B X ANY AUTO BA5E978078 07/01/2015 07/01/2016 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS - - AUTOS PROPERTY DAMAGE $ NON -OWNED i HIRED AUTOS AUTOS Per accident _ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ _ AGGREGATE EXCESS LIAB CLAIMS -MADE ----- -r -- --- - $ --- - DIED RETENTION $ $ WORKERS COMPENSATION PER X TH- STATUTE AND EMPLOYERS' LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/❑N EWC008902 01/01/2015 01/01/2017 $ 1,000,00 ____ _ER_ E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A ----"`--"------ E.L._ DISEASE - EA EMPLOYEE ------�- $ 1,000,00 - - —— under If yes descr: OF OPERATIONS below UESCRIPTION E - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate holder: The City of Fort Collins, a Municipal Corporation, Attn: Bob Adams, Director of Purchasing and Risk Management ***See Notes*** GtK I IrII.:AI t r1VLUtK C.ArvC.CLLAI IVry CIT-FOR The City of Fort Collins (see above) c/o Purchasing Department PO Box 580 Fort Collins, 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. AUTHORIZED REPRESENTATIVE Michael J Schmitt CIC © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE CIT-FOR COLUM-8 INSURED'S NAME Columbine Management Services OP ID: DP PAGE 2 Date 06/26/2015 he City of Fort Collins a Municipal Corporation is listed as additional nsured as pertains to the general liability policy, per written contract. —^� COLUM-8 OP ID: DP AC'ORO DATE (MMlDDIYYYY) �. CERTIFICATE OF LIABILITY INSURANCE 0E(MMID IYY 6/26/2015 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 CONTANAME: Michael J Schmitt CIC Rich & Cartmill Ins of CO PHONE FAX of Colorado LLC A/C No, EMI: 970-356-8030 _ �jac, No): 970-356-8032 8213 W. 20th Street EMAIL Greeley, CO 80634 ADDRESS: Michael J Schmitt CIC — INSIJRER(S) AFFORDING COVERAGE NAIC S INSURER A: Health Cap RRG — INSURED Columbine Management Services INSURER 13: Travelers PropCasualty 25674 Inc. INSURER C : Midwest Employers Casualty Co 802 West Drake Road, Suite 101 Fort Collins, CO 80526 INSURER INSURER E : INSURER F : CnVFRAr.FS CFRTIFICATF NIIMRFR• RFVISION LTR L;tK I IFIL;A I t MULUtK L A1Vl.tLLA 1 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 ACCORDANCE WITH THE POLICY PROVISIONS. 281 N. College Avenue PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522-0580 Michael J Schmitt CIC © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD