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Home My WebLink About446619 NORTH RANGE BEHAVIORAL HEALTH - INSURANCE CERTIFICATE (9)7628/2018 (MM/DD/YYYY) AIR" 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 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 Donna Birleffi NAME: Professional Risk LLC jPAH/GONI o, Ext): (970) 356-8030 _ FA" N.): (970) 356-6032 ---- -- 8213 W.20th St ADDRESS:donna.birleffi@proriskllc.com Greeley CO 80634 INSURED North Range Behavioral Health 1300 N 17th Avenue INSURE _ S) AFFORDING COVERAGE INSURER A -Philadelphia Insurance CO INSURERB:Pinnacol Assurance INSURER C :Lloyds_ Of London INSURER D : INSURER E : Greeley CO 80631 I INSURER F : n 111 le t%CDTICif ATC All IRAC2CD•l A—1 Q All RFVIftInN NIIMRFR• NAIC N 18058 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. ILgRR ADDL BR' TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP ' LIMITS M X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000 , 000 A CLAIMS -MADE X OCCUR DAMAGETO RENTED PREMISES Ea occurrence 1,000 000 $ r MED EXP (Any one person) X Professional Liability X PHPK1839283 7/1/2018 7/1/2019 $ 20,000 PER_SO_N_AL & AD_V INJURY A X $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 _HIPAA GEN'L AGGREGATE LIMIT APPLIES PER PH5D1358091 PRODUCTS - COMP/OPAGG ---- ---- -- HIPAA Limit $ 3,000,000 POLICY PRO R LOC JECT OTHER: $ 50,000 AUTOMOBILE LIABILITY [Ea accidentL __ $ '1, 000, 000 $ A X ANY AUTO ALL OWNED SCHEDULED PHPK1839283 AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS_(Per BODILY INJURY Per person) 7/1/2018 7/1/2019 BODILY INJURY (Per accident) PROPERTY DAMAGE accident) _- __ $ $ $ 5,000 Medical payments X UMBRELLA LIAB OCCUR EACH OCCURRENCE_ $ 2,000,000 AGGREGATE $ 2,000,000 A CESS LIAR X CLAIMS -MADE �4"IED $ X RETENTION$ 10,000 PHUB634797 7/1/2018 7/1/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN ANY PROPRIETOR/PARTNER/EXECUTIVE X ER TAT TE E_R E.L. EACH ACCIDENT $ 1 OOO OOO - E.L. DISEASE - EA EMPLOYE $ 1,000,000 B OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 4044331 7/1/2018 7/1/2019 IE.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under. DESCRIPTION OF OPERATIONS below C 1 Privacy ESH02610560 I 7/1/2018 7/1/2019 1 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins, Colorado, a Municipal Corporation, is listed as additional insured as their interest may appear, per written contract. rF:PTIFI(_ATF wni n;=p CANCELLATION City of Fort Collins, Colorado a Municipal Corporation 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 Dionne Perez/DP U 19US-2014 ACOKL7 GUKPL)KA I IUN. All rlgnts reservea. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)