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HomeMy WebLinkAboutRFP - 7601 HEALTH & WELLNESS PROGRAM PROVIDER - SENIOR CENTER (3)DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B 5/13/2014 DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B DocuSign Envelope ID: 470295E7-5F1C-4156-BC4E-770609298C6B Director of Purchasing & Risk Management Gerry Paul CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NOTEPAD: INSURED'S HOLDER CODE NAME DATE PAGE CITFOR COLUM-8 2 Columbine Management Services, OP ID: DP 05/05/14 The insured City as of pertains Fort Collins, to the a general Municipal liability Corporation policy, is listed per written as additional contract. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Michael J Schmitt CIC COLUM-8 OP ID: DP 05/05/2014 Phone: 970-356-8030 Rich & Cartmill Ins of CO of Colorado LLC 8213 W. 20th Street Greeley, CO 80634 Michael J Schmitt CIC Fax: 970-356-8032 Health Cap RRG Columbine Management Services, National Fire Ins Co of Hartfo 20478 Inc. 947 Worthington Circle Fort Collins, CO 80526 Midwest Employers Casualty Co 1,000,000 AX X HRG-CO01-0001-OC-10 07/01/2013 07/01/2014 100,000 X 5,000 1,000,000 X Professional Liab 3,000,000 Included X Emp Ben. 1,000,000 1,000,000 BX 4022574800 07/01/2013 07/01/2014 X C EWC008902 01/01/2014 01/01/2015 1,000,000 1,000,000 1,000,000 Certificate Bob Adams, Director holder: The of Purchasing City of Fort and Collins, Risk Management a Municipal Corporation, Attn: ***See Notes*** CITFOR The City of Fort Collins (see above) c/o Purchasing Department PO Box 580 Fort Collins, CO 80522