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Home My WebLink About129656 DELTA DENTAL OF COLORADO - INSURANCE CERTIFICATE (6)pszoaizn�xrz DATE (MMMDNYYY) ACOR& CERTIFICATE OF LIABILITY INSURANCE 07/23/2018 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. H 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 Ne 1705 17th Street �� = E�ALL denaccounttecheeimacory.com Suite 100 INSURE S AFFORDING COVERAGE NAICS Denver, CO 80202 INSURERA:FRDMtAL INS CO (Chubb) 20281 INSURED INSURERS: TRUMBULL INS CO(Hartford Ina Co) 27120 Delta Dental of Colorado Colorado Dental Service Inc. dba INSURERC: 4582 S. Ulster at., Suite 800 INSURERD: INSURER E : Denver, CO 80237 INSURER F: cnVFRer.FR CFRTIFICATF NIJURFR• 53450181 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 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 ADDLSUBR -_--- POLICY NUMBER POLICY EFF MM1DD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERALLIA8UJTY 35775020 11/12/17 11/12/18 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR DAMAGE TO RENTED— PREMISES Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL SADVINJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG i Included POLICY LJ JEC7 l7] LOC $ OTHER: A AUTOMOBILE LIABILITY 1770207861 11/12/17 11/12/18 COMBINEDSINGLELIMIT (Eaaccident) t 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED = AUTOS ONLY Y AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per $ $ A Z UMBRELLA LIAS X OCCUR 79790815 11/12/17 11/12/18 EACH OCCURRENCE f 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DIED I E RETENTION$ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNERIEXECUTIVE a OFFICER/MEMBEREXCLUE (Mandatory In NH) NIA 34WWIB0656 08/01/18 08/01/19 Y PTAT TE ERH E.L. EACH ACCIDENT = 500,000_ E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500, 000 If yes, descdbe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it mors space 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. l:tK 1 IFIGA I t_ 2ity of Fort Collins PO Box 580 Fort Collins, CO 80522 ACORD 25 (2016103) SDZM 53450181 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 USA �//',A� / ��# %) 18S8-2U15 AGUKU GUKYUKA I IUN. All ngnts reserVBO The ACORD name and logo are registered marks of ACORD C) a 7 W