No preview available
HomeMy WebLinkAbout446619 NORTH RANGE BEHAVIORAL HEALTH - INSURANCE CERTIFICATE (10)NORTH12 OP D: D D�06129/2017 M/DD/YYYY) �. CERTIFICATE OF LIABILITY INSURANCE 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 have ADDITIONAL INSURED provisions or 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). 970-356-8030 CONTACT Michael J Schmitt CIC PRODUCER NAME_____._ Rich & Cartmill Ins of CO PHONE 970-356-8030 FAX 970-356-8032 of Colorado LLC (A/C, No, Ext):_ _ (AIC, No)_ 8213 W. 20th Street E-MAIL _ADDRESS.: —_.._.— Greeley, CO 80634 Michael J Schmitt CIC __. INSURER(SIAFFORDING OVERAGE NAIC# INSURER A: Philadelphia Insurance Co 23850 INSURED North Range Behavioral Health INSURER B : Pinnacol Assurance 1300 N 17th Avenue INSURER C : Lloyds of London Greeley, CO 80631 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 ADDL SUB POLICY EFF POLICY EXP LTRTYPE OF INSURANCE POLICY NUMBER / MM/DD1Y LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ 1,000,000 CLAIMS -MADE I X OCCUR X PHPK1676246 07/01/2017 07/01/2018 DAMAGES RENTED 1,000,000 X Professional Liab MED EXP (Any oneperson) 20,000 X HIPAA PHSD1258227 07/01/2017 07/01/2018 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ jpe7 L' J I OTHER: PHPK1676246 PHUBS90527 GENERAL PRODLI HIPAA A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -AWNED Al1TOS ONLY AUTOS ONLY 07/01/2017 07/01/2018 COMBINE JEaeccide It -BODILY BODILY II PROPERI Apqr accid A X UMBRELLA LAB EXCESS LIAS OCCUR CLAIMS -MADE 07/01/2017 07/01/2018 EACH C NX A REG, DEC X RETENTION $ 10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE El OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESURIPI ION OF OPERAI IONS below N/A N /A _. _ 07/01/2017 07/01/2018 X PER SIB. E.L. EACI- E.L. DISE E.L. DISE _ C Privacy ESG01269611 07/01/2017 07/01/2018 Privacy ,pE RIFT OF OP�RATIOryS / �OCATJONS / yCHICLE$P A�QgD 10p1, Add(tional jter�A rks Syhetlule, may be attached if more space is required) It o O Co Ins, o ora o, a unlcl a or oration, Is listed as additional insured as their interest may appear, per written contract. CIT-FMU City of Fort Collins, Colorado A Municipal Corporation 300 LaPorte Ave PO Box 580 Fort Collins, CO 80522 LIMIT 1 „ 1 1 1 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NORTH12 QUID: DP ACOR O [:�D.OT�E�M/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/2017 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 have ADDITIONAL INSURED provisions or 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). 970-356-8030 CONTACT Michael J Schmitt CIC PRODUCER NAME: Rich & Cartmill Ins of CO PHONE 970-356-8030 FAX 970-356-8032 of Colorado LLC (A/C, No, Ext): (A/C, No): 8213 W. 20th Street E-MAIL Greeley, CO 80634 - — -- — - --- Michael J Schmitt CIC INSURER(SLAFFORDING COVERAGE- NAIC # INSURED North Range Behavioral Health 1300 N 17th Avenue Greeley, CO 80631 INSURER F : Philadelphia Insurance Co Pinnacol Assurance Lloyds of London 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 TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE 111 CLAIMS -MADE [X]OCCUR X PHPK1676246 07/01/2017 07/01/2018 DAMAGES MENTED 1,000,0occurrence) $00 X Professional Liab _ MED EXP (Any oneperson) 20,060 X HIPAA PHSD1258227 07/01/2017 07/01/2018 PERSONAL & ADV INJURY $ 1,000,000 L AGGREGATE LIMIT APPLIES PER: POLICY D PRO I X LOC JECT A AUTOMOBILE LIABILITY X ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON- WNED AUTOS ONLY AUTO ONLY A X UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS -MADE DED X RETENTION$ 1000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) C lPrivacy l:lf7a�_� HPK1676246 1 07/01/20171 07/01/2018 1 HUB590527 1 07101/20171 07/01/2018 1 er_r_oor_eTo l e 2,000,0001 01/01/2017 07/01/2018 c L EACH ACCIDENT nv 1100,0001 269611 1 07/01/20171 07/01/2018 1 Privacy 1 3,000,0001 fASCF� FTION OP TI yS / LQCA,TIONS VEHIC (ACOR j01, Additi nal Remarks $che le ay be attached if more space is required) e (.It o��or �oPlins is listec�as a c itiona�insurec�as pertains10 i�ie General and Auto Liability policies, per written contract. CIT-FOR City of Fort Collins -Financial Services Purchasing Division 215 N Mason St. --2nd Floor 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD