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HomeMy WebLinkAbout129656 DELTA DENTAL OF COLORADO - INSURANCE CERTIFICATE (3)11S21a Ml2-12 ACOCERTIFICATE OF LIABILITY INSURANCE DATE,a/co15 11/24/2RO 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 1-303-534-4567 IMA, Inc. - Colorado Division CONTACT NANE: _ --- - PHONE FAX (AIC Nt1 GaU AIC No : __ _ -- ---__ E-MAIL denaccounttechB6<imacorp. COm ADD 1705 17th Street INSURE S AFFORDING COVERAGE NAIL • Suite 100 INSURERA: FEDERAL INS CO (Chubb) 20281 Denver, CO 80202 INSURED INSURERS: PIMNACOL ASSUR 41190 Delta Dental of Colorado Colorado Dental Service Inc. dbn INSURER C : 4582 S. Ulster St., Suite 800 INSURER D: INSURER E : 1 INSURER F: Denver, CO 80237 rnVFRAnFR CFRTIFICATF NIINIRFR• ASdg1055 RFVISIniu NIIYRFR• 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. I�TSR R TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDYYYY/Y M IDD/YYYY LIMITS A X COMMERCIAL GENERALLIABILrtY 35775020 11/12/15 11/12/16 EACH OCCURRENCE f 1,000,000 CLAIMS -MADE I - I OCCUR DAM EMO�EN7€ice IS ISES Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY i 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GENT POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ Included $ OTHER: A AUTOMOBILE LIABILITY 1470207861 11/12/15 11/12/16 COEaMBINED acddentSINGLE LIMIT i 1,000,000 BODILY INJURY (Per person) f ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ 11 NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident _ i - - $ A X UMBRELLA LIAB X OCCUR 79790815 11/12/15 11/12/16 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAR CLAIMS -MADE DED X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER)EXECUTIVE OFFICER/MEMBER EXCLUDED9 D N I A 908872 08/Ol/15 08/Ol/16 OTH- X STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE f 500, 000 (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT : 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K mom apace is required) City of Fort Collins is included as Additional Insured on the General and Automobile Liability Policies if required by written contract or agreement subject to the policy terms and conditions. l:ANULLLAI WN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE /�%//,/A Fort Collino, CO // /r�I'�l 80522 USA [ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ashmcclain 45491055 rV G., O rV V rV z uJ