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Home My WebLink About223028 THE FAMILY CARE CONNECTION INC - INSURANCE CERTIFICATE (9)OP ID: SC ,acoRr� CERTIFICATE OF LIABILITY INSURANCE DATE �--" �� 02/151201815/2018 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 CONTACT Front Range Insurance Group PHONE FAX 2002 Caribou Drive, Ste. 101 Fax: Ac No Ext : A c No): Fort Collins, CO 80525 E-MAIL David A. Wooldridge LUTCFAAI PRODUCER CUSTOMER ID #: FAMIL-2 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Family Care Connection INSURERA: Scottsdale Insurance Company Inc INSURERB: Pinnacol Assurance 41190 707 3rd St, Unit E1 Windsor, CO 80550 INSURERC: INSURER D : INSURER E : INSURER F : r()VFRA(;FR rFRTIFIrATF NIIMRFR- RFVISI()W 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 LTR TYPE OF INSURANCE A DL� UBR POLICY NUMBER POLICY MM DYYY D/Y POLICY EXP MM DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X CPS2785935 CPS2785935 02/14/2018 02/14/2018 02/14/2019 02/14/2019 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 X ErrorsorOmissio GENERAL AGGREGATE $ 2,000,00 GEN1 AGGREGATE LIMIT APPLIES PER X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A 4199096 02/01/2018 02/01/2019 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE -EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 i DESCRIPTION OF OPERATIONS / LOCATIONS / 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. l:tK 1 IFIL:A I t r1ULUtK CITY OF City of Fort Collins 215 N Mason St 2nd Floor 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 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD