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HomeMy WebLinkAbout541195 MARATHON HEALTH INC - INSURANCE CERTIFICATE (2)�-� MARAHEA-01 AMERRITT ACORIT CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/ `....-� 01 /18/2018Y) 018 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 suchpendorsement(s). PRODUCER NAME CT Amy Merritt Hickok & Boardman, Inc. 346 Shelburne Rd jacNN , Ext : (802) 383-1657 �, No):(802) 658-0541 Burlington, VT 05401 E- DRL . amerrl hbinsurance.com INSURED Marathon Health, LLC d/b/a Marathon Health 20 Winooski Way, Suite 400 Winooski, VT 05404 &�MIMD A!_ me r`FRTIGI!`ATF NI IMRFR- INSURER A: Columbia Casualty Co INSURER B : Hartford Casualty Ins Co INSURER C : Hartford Ins Co of the Midwest INSURER D_: Endurance American We Ins Cc INSURER E : INSURER F : RFVIRlr)N NI IMRFR- 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 LTRTYPE OF INSURANCE POLICY NUMBER M/DD/Y DDN LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 51000,000 CLAIMS -MADE �X OCCUR X HMA 1064390164-12 01/19/2018 01/19/2019 100,000 $ DAMAGE TO RENTED PREMISES Ea occurrence $ 5,000 MED EXP (Any one on 5,000,000 $ PERSONAL 8 ADV INJURY $ 5,000,000 $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY n jt& LOC GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ OTHER. B AUTOMOBILE LIABILITY COMBBIIN SINGLE LIMIT $ 11000,000 BODILY INJURY Per ANY AUTO X 04 SBA UK8133 SB 01M9/2018 01/19/2019 $ BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS Ep X AUTOS ONLY X AUTOS ONLY PPeOr acadeTDAMAGE $ A UMBRELLA LU►B OCCUR EACH OCCURRENCE $ 10,000,000 EXCESSLWB CLAIMS -MADE X HMC 4031941072-5 01/19/2018 01/19/2019 X H AGGREGATE $ 10,000,000 DIED RETENTION $ $ i C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY AWe PROPRIETOR/PARTNER/EXECUTIVE FICER/MEMBER EXCLUDED? ❑N aYIN ndatoryin NH) N /A 04 WEC CF8660 01/19/2018 01/19/2019 X PTA OTH ER E.L. EACH ACCIDENT 500,000 $ E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT 500,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below A Medical Malpractice HMA 1064390164-12 01/19/2018 01/19/2019 Claims Made Coverage 5,000,000 D Cyber Liability PRO10008507701 01/19/2018 01/19/2019 Claim/Agg 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Named insured includes, Marathon Health, LLC, Marathon Health Holdings, Inc., MH 101, PC, MH 102, PC, MH Health Care Services, PC, MH Medical Services, PC, MH Nursing of Indiana, PC, Marathon Nurse Practitioner in Adult Health, PC, MH Nursing of California, PC and MH Health of Kansas, PA. Professional Liability (Medical Malpractice) claims retro date on professional policy: 01.19.2005 Cyber liability claims retro date: 05/29/2009 MAIL RETURNED/NOT DELIVERABLE AS ADDRESSED City of Fort Collins is included as an additional insured under the general liability, auto liability, and excesss liability as required by written contract or agreement. City of Fort Collins 214 N Howes Street Fort Collins, CO 80521 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD