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Home My WebLink About129656 DELTA DENTAL OF COLORADO - INSURANCE CERTIFICATE (5)P526W280U2 c DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANC 08/08/2017 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 1-303-534-4567 CONTACT NAME: —_ IMA, Inc. - Colorado Division PHONE FAX JA&,No. Extk _ C No: EMAIL denaccounttechs@imacD Con 1705 17th Street ADDRESS: �• Suite 100 INSURERS AFFORDING COVERAGE NAIC8 Denver, CO 80202 INSURERA: FOAL INS CO (Chubb) 20281 INSURED INSURER B: TRUMBULL INS CO(Nartford Ins Co) 27120 Delta Dental of Colorado INSURER C: Colorado Dental Service Inc. dba 4582 S. Ulster St., Suite 800 INSURERD: INSURER E : Denver, CO 80237 INSURER F: rnvcDAI-cc rFDTIFICATF MIIURFR• 50554222 REVISION NUMBER! THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEI OW 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 ADDL SUER POLICY NUMBER POLICY EFF I MMMD POLICY EXP MM/DD OMITS A % COMMERCIAL GENERAL LIABILITY % CLAIMS -MADE L- OCCUR 35775020 11/12/16 11/12/17 EACH OCCURRENCE $ 1,000,000 rED PREM SES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY f 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY ❑11 LOC OTHER: GENERAL AGGREGATE i 2,000,000 PRODUCTS - COMP/OPAGG f Included f A AUTOMOBILELlAB1UrY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X: AUTOS 1670207861 11/12/16 11/12/17 COMBINED SINGLE LIMIT Ea accident = 1,000.000 - BODILY INJURY (Per person) $ f BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident $ $ A g UMBRELLA LAB EXCESS LIAM Z OCCUR CLAIMS -MADE 79790815 11/12/16 11/12/17 EACH OCCURRENCE f 1,000,000 AGGREGATE $ 1,000,000 DIED I X I RETENTION $ 0 $ H WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1 A 34WSCZH0656 08/01/17 08/01/18 % PER STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT f 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more apace Is required) City of Fort Collins is included as Additional Insured on the General and Automobile Liability Policies if required by written contract or agreement subject to the policy terms and conditions. GtK I IrIL A l t riULUtM a Mims c I swim SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE (Fort Collins, CO 80522 /�& I USA 111 U 1988-2U14 AGUKU GUKPUKA I IUN. All rlgnis reserve0 ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD spmaestas 50554222 00 00 W