HomeMy WebLinkAbout972167.tiff ACORDM CERTIFICATE OF LIABILITY INSURANCE ESR MC
DATE(MM/DD/YV)
PRODUCER AUCOM 1. 05/06/97
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MIMS INTERNATIONAL, LTD. .. _. . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
401 DINTERN VALLEY RD # 610 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
'VSON MD 21204 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
MARY CLAIRE GOFF -- `
A NATIONAL UNION FIRE INS. CO.
PnoneNa. 410-296-1500 FaxNa. 410-296-1741 COMPANY
INSURED
COMPANY
- - B INSURANCE CO OF THE ST. OF PA.
AMERICAN MEDICAL RESPONSE, INC COMPANY
(SEE ATTACHED SHEET) C
2821 South Parker Rd., # 1105
Aurora CO 80014 COMPANY
D
COVERAGES
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.
co
LTq POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE POLICY NUMBER
�L— DATE(MM/DOWY) DATE(MM/DD/YY) LIMITS
GENERAL LIABILITY
GENERAL AGGREGATE $ 10,000,000
A X COMMERCIAL GENERAL LIABILITY
RMGL1437718 03/15/97 09/01/99 PRODUCTS-
. CLAIMS MADE X OCCUR COMP/OP AGG $ 5,000,000.000
OWNER'S&CONTRACTOR'S PROT PERSONAL&ADV INJURY $ 5,000,000
X PROFESSIONAL LIAR EACH OCCURRENCE
Any $ 5,000,000.
INCLUDED FIRE DAMAGE(Any one fire) I s 1,000,000.
AUTOMOBILE LIABILITY MED EXP lAny one Parson/ $ 50,000.
COMBINED SINGLE LIMIT $ 5,000,000.
A X ANY AUTO RMCA1438747 03/15/97 09/01/99
X ALL OWNED AUTOS
X SCHEDULED AUTOS BODILY INJURY
(Per person/ 5
X HIRED AUTOS
X NON-OWNED AUTOS BODILY INJURY 5
(Per accident)
PROPERTY DAMAGE 5
GARAGE LIABILITY
ANY AUTO AUTO ONLY-EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
EXCESS LIABILITY AGGREGATE $
UMBRELLA FORM EACH OCCURRENCE $$
OTHER THAN UMBRELLA FORM AGGREGATE 5
WORKERS COMPENSATION AND $
EMriOYERB'LIABILITY X WC STATU- OTH-
TORVLIMITS Efl
B THE PROPRIETOR/ EL EACH ACCIDENT $ 5,000, 000.
PARTNERS/EXECUTIVE X INCL RMWC1131827 03/15/97 09/01/99 EL DISEASE-POLICY LIMIT $
OFFICERS ARE: EXCL 5,000,000,
OTHER EL DISEASE-EA EMPLOYEE $ 5,000,000.
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICEES/SPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
WELDCO2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
WELD COUNTY 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
DEPARTMENT OF HEALTH BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
1517 - 16TH CT. OF ANY KIND UPON THE COMPANY.ITS AGENTS OR REPRESENTATIVES.
GREELEY, CO 80631 AUTHORIZED REPRESENTATIVE
ACORD 25-5 (7/95) MARY CLAIRE GOFF
?Oak 972167
9// 7/77
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