HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - 2004 INSURANCEACORD,a, CERTIFICATE OF LIABILITY INSURANCE 03/`26/2004
PRODUC7(641)842-21315FAX2135 FAX (641) 828-2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
McKaAgency , Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
106 reet ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P 0Kno138 INSURERS AFFORDING COVERAGE NAIC #
INSURED Sports & Rec.Providers Assn, Purchasing Group INSURER A: CHUBB Custom Insurance Company
National Pedicab Service Association INSURER B:
O I d Town Ped i cabs INSURER C:
320 Smith St INSURER D:
Fort Collins, CO 80524 INSURER E:
COVERAGES
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.
INSRM
E OF INSURANCE
POLICY NUMBERDATE
POLICY EFFECTIVE
iMMIDDNYI
POLICY EXPIRATION
DATE IMM/DDIYYI
LIMITS
AIncludes
BILITY
CIAL GENERAL LIABILITY
IMS MADE O OCCUR
Athletic
7953 0099
03/24/2004
10/15/2004
EACH OCCURRENCE
$ 1,000,00
DAMAGE TO RENTED
$ 5O OO
MED EXP (Anyone person)
$ Non
PERSONAL & ADV INJURY
$ 1,000,00C
GENERAL AGGREGATE
$ 2, OGO, OO
i c i pants
PRODUCTS - COMP/OP AGG
$ 1,000,00
GATE LIMIT APPLIES PER:
PRO LOC
JECT
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EA ACC
AUTO ONLY: AGG
$
$
EXCESS/UMBRELLA LIABILITY
OCCUR El CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTH-
T
$
MPLOYE
7DISEASE
$
ICY LIMIT
$
B
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
overage for 2 Pedicabs, March 24, 2004 through October 15, 2004
ertificate holder is an Additional Insured but only with respect to liability arising out of
he operations of the above named insured.
City of Fort Collins
Purchasing
PO Box 580
Fort Collins, CO 80522
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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Scott Ziller/DARCY
ACORD 25 (2001108) VAI UKU uumrvr l Ivim Ivoo
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.
ACORD 25 (2001/08)