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Home My WebLink AboutSERTOMA INTERNATIONAL - INSURANCE CERTIFICATEACORM CERTIFICATE OF LIABILITY INSURANCE 09/01/2007 06/20/200 PRODUCER LOCKTON COMPANIES, LLC-1 KANSAS CITY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 444 W. 47TH STREET, SUITE 900 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR KANSAS CITY MO 64112-1906 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, (816) 960-9000 INSURERS AFFORDING COVERAGE INSURED SERTOMA INTERNATIONAL INSURERA: PHILADELPHIA INSURACE COMPANIES 1073023 AND IT'S SUBSIDIARIES INSURER B : HARTFORD INSURANCE COMPANIES 1912 E. MEYER BLVD INSURER KANSAS CITY MO 64132 INSURER D rnveeAr00 C VDTXTAl D t THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMWDDNY)LIMITS POLICY EXPIRATION GENERAL LIABILITY EACH OCCURRENCE 1,000,000 FIRE DAMAGE (Any one fire $ 100,000 A X COMMERCIAL GENERAL LIABILITY PHPK135912 09/01/2006 09/01/2007 MED EXP (Any oneperson) $ 5,000 71 CLAIMS MADE [X] OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES P LICY JET X PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY A ANY AUTO PHPK135912 09/01/2006 09/01/2007 COMBINED SINGLE LIMIT (Ea accident) It 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ XXXXXXX HIREDAUTOS NON -OWNED AUTOS X BODILY INJURY (Per accident) $ XXXXXXX X PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE LIABILITY AUTO ONLY -EAACCIDENT $ XXXXXXX OTHER THAN FJt ACC AUTO ONLY: AGG XXXXXXX ANY AUTO NOT APPLICABLE XXXXXXX A EXCESS LIABILITY X OCCUR CLAIMS MADE PHUB050974 09/01/2006 09/01/2007 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ ] 000000 s XXXXXXX UMBREL A FRI XXXXXXX DEDUCTIBLE FORM X RETENTION $ 10.000 XXXXXXX B WORKERS COMPENSATION AND 37WECPL953 09/01/2006 09/01/2007 X WC STATUTORY- DTH- FR EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500.000 A OTHER LIQUOR LIABILITY PHPK135912 09/01/2006 09/01/2007 1,000,000 OCCURRENCE 1,000,000 AGGREGATE DESCRIPTION OF OPERATION&LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECWL PROVISIONS OVERLAND SERTOMA 262 E. MOUNTAIN AVE FT. COLLINS, CO 80524. CITY OF FORT COLLINS IS NAMED AS AN ADDITIONAL INSURED, ON ALL LINES EXCEPT WORK COMP, WITH RESPECTS TO NEW WEST FEST BEER GARDEN OCCURRING AUG 18 & 19 2007 2893467 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF FORT COLLINS DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 300 LAPORTE AVE FORT COLLINS CO 80524 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 S (7/97) For questions regarding this eadalcale, eonlaet tea nund a, lured in tm'ProducW section avow and Opacity tea disrd Coda'SERINW'. ® AL%M CORPORATION I QRR Arthur J. Gallagher & Co. of New York 444 Madison Avenue 20th Floor New York, NY 10022 City of Fort Collins, Purchasing Division 256 Nest Mountain P.O. Box 580 Fort Collins, CO 80522-0580 USA USA This document was brought to you by CertificatesNow and Arthur J. Gallagher & Co. of New York in New York, NY. If you have questions regarding the content of this document, please contact the Producer/Agent listed on the certificate of insurance. The data included in this notice and in the attached document is confidential to ConfirmNet and Arthur J. Gallagher & Co. of New York. cc: The data included in this notice and in the attached document is confidential to ConfirmNet and the party responsible for bringing you this information. Powered BYCertificatesNowTv ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE/DD"YYn O6/19/07 PRODUCER 1-212-994-7100 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher & Co. of New York ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 444 Madison Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 20th Floor New York, NY 10022 Ana Greenfield INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Federal Ina Co 20281 AAF International INSURER B: Travelers Ind CO Of Amer 25666 10300 Ormsby Park Place INSURER C: Travelers Prop Cas Ina Cc 36161 , KY 40223 VV�Lf1I1V VV 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D OF INSURANCE POLICY NUMBER POLICYEFFECTIVE DATE (MWDDNY) POLICY EXPIRATIONTYPE DATE (MMIDONYI LIMITS A GENERAL LIABILITY X COMMERCIALGENERALLIABIL17Y CLAIMS MADE Fx_] OCCUR 35379746 06/30/07 06/30/08 EACHOCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES occurence $1,000,000 MED EXP(Any one person) $N/A PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 10, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS-COMP/OP AGG $2,000,000 A A A AUTOMOBILE LIABILITY ANY AUTO ALLOWNEDAUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEOAUTOS 73225752 (A/O/S) 73261760 (VA) 73261761 (TX) 06/30/07 06/30/07 06/30/07 06/30/08 06/30/08 06/30/08 COMBINED SINGLE LIMIT (Ea accident) $2,000, 000 X BODILY INJURY (Perperson) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE (Peraccident) $ GAR AGE LIABILITY ANY AUTO AUTO ONLY -EA ACCIDENT $ OTHERTHAN EA ACC AUTOONLY: AGG $ $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMSMADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ B C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below TC2EIU8189R541807 TRJUB823KI42607 06/30/07 06/30/07 06/30/08 06/30/08 TH- X I WRY LIM S I OEEL E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE -POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS/VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS City of Fort Collins is an Additional Insured as respects the General Liability Coverage for the work and/or services provided or performed by the Named Insured if required by written contract. City of Fort Collins, Purchasing Division 256 Nest Mountain P.O. Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE USA anagree esooace 0ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 25