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HomeMy WebLinkAbout182670 COLUMBINE MANAGEMENT SERVICES INC - INSURANCE CERTIFICATECOLUM-8 OP ID7 OF ACORO CERTIFICATE OF LIABILITY INSURANCE DATE208/08//0172017 Y) 1 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 970-356-8030 CONTACT Michael J Schmitt CIC _ Rich & Cartmill Ins of CO PHONE FAX of Colorado LLC (A c No, Ext), 970-356-8030 — -sue 970-356-8032 8213 W. 20th Street E-MAIL ---- — Greeley, CO 80634 AUDIKEg "— Michael J Schmitt CIC INSURER(S) AFFORDING COVERAGE _ _NAIC III T — — INSURED Columbine Management Services Inc. 802 West Drake Road Suite 101 Fort Collins, CO 80526 INSURER A Health Cap RRG ' INSURER B Travelers Prop Cas Co of Am 25674 INSURER C State National Insurance INSURER D INSURER E INSURER F Cr)\/FDAr:FC CFDTII=ICATF fJl IMRFD• DG\/ICIrIAI Kill IRAPF:D- 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. .._..._.__---TYPE OF INSURANCE -- - - ---NSD ------WVID - _ INSR IADDL SUBR POLICY EFF POLICY EXP LTRPOLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 CLAIMS MADE X� OCCUR X HRG-0001-0001-OC-14 07/01/2017 07/01/2018 FACHOCCU_RRENCE _- DA^�`GETORENTED $_ _ 100,000 -.PREMISES.(EaoccumQn�g�.._. 5,000 __ MED EXP An oneQrsan)__ ----- X Professional Liab 1,000,000 PERSONAL,BADVINJURY ___ GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 3,000,000 POLICY PE� X LOC Included — I PRODUCTS - COMP/OP AGG $ -- — -- Emp Ben. OTHER 1,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT accldenq---__— .. -- $1,000,000 --------- X ANYAUTO BA5E978078 07/01/2017 07/01/2018 130DILY_INJURY1Per-person) $ — .._. OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident -- (--. ) $ _._ HIRED NON AWNED AUTOS ONLY -__ AUTOS ONE Y PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MAIL AGGREGATE. $ IN D RETENT ION $ C WRKERS COMPENSATION PER X EK H STATUI E i AND EMPLOYERS' LIABILITY YIN NDE092771718 01/01/2018 01/01/2019 ANY PROPRIETOR/PARTNER/EXECUTIVE I I. L I ACH ACCIDENT l 1000,000 01 1IC, R/MEMBER EXCLUDED N / A (Mandatory in NH) - - - - 1,000,000 f yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASEEAEMPLOVEE E L. DISEASE -POLICY LIMIT $_ 1,000,000 I i DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached if more space is required) Certificate holder: The City of Fort Collins, a Municipal Corporation, Attn: Bob Adams, Director of Purchasing and Risk Management **See Notes*** CIT-FOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. (see above) c/o Purchasing Department AUTHORIZED REPRESENTATIVE PO Box 580 Michael J Schmitt CIC Fort Collins, CO 80522 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE CIT-FOR COLUM-8 PACE 2 INSURED'S NAME Columbine Management Services OP ID: DP Date 12/08/2017 the City of Fort Collins, a Municipal Corporation is listed as additional insured as pertains to the General Liability policy, per written contract.