HomeMy WebLinkAboutCOLORADO PHYSICAL THERAPY SPECIALISTS - INSURANCE CERTIFICATEDATE (MM/DD/YYYY)
,a`oRc�`� CERTIFICATE OF LIABILITY INSURANCEF7/21/2017
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 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 CONTACT House Account
NAME:
John C Beckett and Associates Inc A/CNNo,Extp- (970) 484-2805 - (� Noj: (970)484-2885
220 Smith Street E-MAIL
ADDRESS:
__ - INSURERJS) AFFORDING COVERAGE _ _ NAIC 0
Ft. Collins CO 80524 INSURERA:CRC Swett:
INSURED INSURER B -Colombi8 Insur3ISce Company
ColoradoPhysical Therapy Specialis, DBA: Colorado INSURERC:PROASSURANCE SPECIALTY INC CO.
210 W. Magnolia, Suite 110 INSURERD:
INSURER E
Fort Collins CO 80524 INSURERF:
CnVFRAGFS CERTIFICATE NLIMBER:CL1772103132 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.
IICY EXP
LTR R TYPE OF INSURANCE ADDL SUBRi POLICY NUMBER MM DPOLID/YYYY MMICY EFF LDD/YYYY LIMITS
LT
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
i DAMAGE TD-RENNTED -
A CLAIMS -MADE OCCUR
PREMISES_ Ea occurrence $ _
CR161597 7/8/2017 7/8/2018 MED EXP (Any one person) $
PERSONAL & ADV INJURY $
N'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 1,000,000
R
POLICY JE° LOC
PRODUCTS - COMP/OP AGG $
OTHER:
Employee Benefits $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT -, $ 1,000,000
(Ea accident)
B
ANY AUTO BODILY INJURY (Per person) $
�------------- _ -
ALLOS71APR342026SCHEDULED 10/4/2016 ! 10/4/2017 BODILY INJURY (Peraccidern) $
AUTOS AUTOS
-' AU OS EO PROPERTY DAMAGE
X HIRED AUTOS I_ �I Per accident)_ $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS -MADE AGGREGATE $
FJ
DED RETENTION $ :$
WORKERS COMPENSATION PTAER - TH-
�___I STUTE 1_-LE�__
________
AND EMPLOYERS' LIABILITY Y / N. E.L. EACH ACCIDENT
$
ANY PROP RIETOR/PARTNER/EXECUTIVE _
(OFFICER/MEMBER EXCLUDED? N / A ------ -
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT
$
C
E&O
IAF'C9266916 10/11/2016 10/11/2018 OCCURANCE 1,000,000
3,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER IS AN ADDITIONAL INSURED PER WRITTEN CONTRACT ON THE GENERAL LIABILITY FOR THE ONGOING
OPERATIONS OF THE INSURED.
GtK I IFIGA It MULUtK l.H ry1.CLLH I IVIY
(970)221-6775
CITY OF FORT COLLINS
ACCOUNTING DEPARTMENT
PO BOX 580
FORT COLLINS, CO 80522-0580
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
Robert Rendon/RR
�D 19EE. 2914 A,1pRD rCIRPOKA I I(-'N. All rlOntS r'eservea.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)