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HomeMy WebLinkAbout129656 DELTA DENTAL OF COLORADO - INSURANCE CERTIFICATE (7)P526002&N12 T c �r-. DATE (MMIDD/YYYY) 1•.. CERTIFICATE OF LIABILITY INSURANCE 11/27/2017 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 1-303-534-4567 CONTACT NAME: IRA, Inc. - Colorado Division PHONE FAX (AIC. NQ. Ei01�---------- -- IAIG. No): — E-MAIL denaccountteche4imac0 com 1705 17th Street ADDRESS: __- rD• Suite 100 _ _ INSURE�S►AFFORDINGCOVERAGE _ NAIC8 Denver, CO 80202 INSURER A: FSDEIL&L INS CO (Chubb) 20281 INSURED INSURER6: TRUMBULL INS CO(Bartford Ina Co) 27120 Delta Dental of Colorado INSURER C Colorado Dental Service Inc. dba - 4582 S. Ulster St., Suite 800 INSURERD: INSURER E : Denver, CO 80237 1 INSURER F: CAVFRAGFR CFRTIFICATF NIIMRFR• 51414837 RFVISION NIIMRFR- 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IMM WVD POLICY NUMBER IMMIDDIYYYY MMID LIMITS A X: COMMERCIAL GENERALLIWRM 35775020 11/12/17 11/12/18 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE L=J OCCUR GE TO RENTED pR M SES Ea occurrence) f 1,000,000- MED EXP (Any one person) f 10,000 PERSONAL 6 ADV INJURY $ 1, 000, 000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L POLICY1:1 JJEECT E LOC PRODUCTS - COMP/OP AGG $ IDCludsd $ OTHER: A AUTOMOBILE LIABILITY 1770207861 11/12/17 11/12/18 COMBINED SINGLE LIMIT Ea accident = 1,000,000 BODILY INJURY (Per person) S ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED Z AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ t A g UMBRELLA LIAO B OCCUR 79790815 11/12/17 11/12/18 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 10000,000 EXCESS LIAR CLAIMS -MADE DED X'. RETENTIONS 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE -1 OFFICER/MEMBER EXCLUDED? rN (Mandatory In NH) NIA 34WSCIB0656 OB/Ol/17 OB/Ol/18 Y STATUTE OTH EIR E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500, 000 It yes, describe under DESCRIPTION OF OPERATIONS 1010o__r DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space 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. Uk:K I IFH:A 1 t MULUtK City of Fort Collins PO Box 580 Fort Collins, CO 80522 ACORD 25 (2014/01) thcr5350 S1414837 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 Zo USA ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD N O N