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HomeMy WebLinkAbout223028 THE FAMILY CARE CONNECTION INC - INSURANCE CERTIFICATE (8)OP ID: SC ACORO CERTIFICATE OF LIABILITY INSURANCE D03103120YYYY) 3/03/2016 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 Phone: 970-223-1804 NAME CT Front Range Insurance Group Fax: 1100 Haxton Drive Suite 100 Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI PHONE FAX Arc No Ext :(AC,No): EMAIL ADDRESS: PRODUCER FAMIL-2 CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED The Family Care Connection INSURER A: Scottsdale Insurance Company Inc INSURER B : Plnnacol Assurance 41190 6 Heather Circle Colorado Springs, CO 80906 INSURER C: Republic Vanguard Insurance Co INSURER D : INSURER E : INSURER 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. INSR LTR TYPE OF INSURANCE A U POLICY NUMBER MM/DD/YYYY MM DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE " 1 OCCUR X CPS2416510 CPS2416510 02/14/2016 02/14/2016 02/14l2017 02/14/2017 EACH OCCURRENCE $ 1,000,00 DAMAGE TO PREMISES Ea occur ence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 X Errors or Omissio GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. X POLICY 77 PROJECT LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ C C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X CN0555052601 CN0555052601 01/14/2016 01/14/2016 01/14/2017 01/14/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4146418 03/01/2016 03/01/2017 X WC STATU- OTH- T RY LIMIT ER E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 I I I � 7 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Fort Collins has been named as additional insured with respects General Liability and Auto Policy. CERTIFICATE HOLDER CANCELLATION CITY OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins 215 N Mason St 2nd Floor AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD