HomeMy WebLinkAbout566707 COLORADO IN MOTION - INSURANCE CERTIFICATEA�o!z-1 'a CERTIFICATE OF LIABILITY INSURANCE
DATE(Mo7/o5/2o1 YY)
/2018M/DDIYa
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).
PRODUCER
1 st American Fort Collins LLC
220 Smith Street
Ft. Collins CO 80524
CONTACT Lisa Johnson
NAME:
HONE Ext : (970) 484-2805 FAX, No): (970) 484-2885
E-MAIL lisa@beckettinsurance.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: Liberty Mutual Insurance
INSURED
Colorado Physical Therapy Specialis, DBA: Colorado in Motion
210 W. Magnolia, Suite 110
Fort Collins CO 80524
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: MASTER 2018-2019 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MMIDDY/YYYY
MM DDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
rA
CLAIMS -MADE OCCUR
E TO HEN ILL)
PREMISES Ea occurrence
300,000
$
MED EXP (Any one person)
$ 15,000
iBZS58882497
06/04/2018
06/04/2019
PERSONAL & ADV INJURY
$ 1,000,000
I
LAGGREGATE LIMITAPPLIES PER.
GENERALAGGREGATE
$❑ 2,000,000
PRODUCTS-COMPIOPAGG
$2,000,000
PRO- ECT ❑ LOC
POLICY RO-
M'OTHER
$
.
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
A
OWNED rSCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
BAS58882497
06/04/2018
06/04/2019
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
EXCESS LIAB
NO COVERAGE
DED RETENTION $
_
1
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
NO COVERAGE
PER
STATUTE EERR
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I 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.
CERTIFICATE HULDEK aiMnliGLLM 11V1\
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF FORT COLLINS ACCORDANCE WITH THE POLICY PROVISIONS.
ACCOUNTING DEPARTMENT
AUTHORIZED REPRESENTATIVE
PO BOX 580
FORT COLLINS CO 80522-0580 r rtuYN'x—
V 18S8-ZU1* AtUKU UUKrUKAI IUK. /All ngms FUb6lvCu.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD