HomeMy WebLinkAboutCOLORADO PHYSICAL THERAPY SPECIALIST - INSURANCE CERTIFICATEDATE (MM/DD/YYYY)
AC" " CERTIFICATE OF LIABILITY INSURANCE
7/21/2017
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 CONTACT House Account
NAME:
John C Beckett and Associates Inc PHONE
,Ext): (970) 484-2805 _ I F�AXC NoI: (970)484-2885
220 Smith Street E-MAIL
ADDRESS:
INSURER(q)AFFORDING COVERAGE NAIC 0
Ft. Collins CO 80524 INSURERA:CRC Swett
INSURED INSURERB:COlOMbia Insurance CO
--- - _
Colorado Physical Therapy Specialis, DBA: Colorado INSURERC:PROASSURANCE SPECIALTY INC CO.
210 W. Magnolia, Suite 110 INSURERD:
INSURER E
Fort Collins CO 80524 INSURERF:
(--nVFRARFC CFRTIFICATF NI IMRFR•CL1772103132 R;=VISION Nt)MRER:
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 ADDLSUTYPE OF INSURANCE INSD W D POLICY NUMBER MM DPOLIPOLICYCY EFF DNYYY MM
LTR DDNYYY LIMITS
LT
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
DAFMGE-TUtFENTE
A
CLAIMS -MADE OCCUR
PREMISES (Ea occurrence)$
CR161597 7/8/2017 7/8/2018 �MEDEXP(Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE 1 $ 1,000,000
PRO-
POLICY JECT I LOC
_
- -'- - - - - -
( PRODUCTS - COMP/OP AGG $
OTHER
Employee Benefits $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
B
ANY AUTO
I BODILY INJURY (Per person) $
r- -- - - --- - -
ALL OWNED SCHEDULED
71APR342026 10/4/2016 BODILY INJURY(Per accident) $
_
X� AUTOS AUTOS
NON -OWNED
PROPERTY DAMAGE
_ HIRED AUTOS (_ AUTOS
�10/4/2017
$
Per accident)-_ _
UMBRELLA LIAR OCCUR
EACH OCCURRENCE
- — -
I $ - -- - —
EXCESS LIAB CLAIMS -MADE
!
$
DEDAGGREGATE
RETENTION $
i $
WORKERS COMPENSATION
'AND
PER H-
_,_STATUTE
!
EMPLOYERS' LIABILITY YIN N
ANY PROPRIETOR/PARTNER/EXECUTIVE -''
E.L. EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED? INIA',
------- ------
_
- -- --
(Mandatory in NH)�
E. L. DISEASE - EA EMPLOYE
$
0 yes, describe under
DESCRIPTION OF OPERATIONS below !
E.L. DISEASE -POLICY LIMIT
$
C
E&O
AFC9266916 10/11/2016110/11/2018,OCCURANCE 1,000,000
i 3,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / 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.
GtK I WIGA I It HULUtK t AN' rCL.LA I IVIV
(970)221-6775
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF FORT COLLINS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCOUNTING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 580
FORT COLLINS, CO 80522-0580 AUTHORIZED REPRESENTATIVE
Robert Rendon/RR
rJ 19uu_2914 ".CORD G(JRPOK/1IKL`N. All rights reserve[l.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)