HomeMy WebLinkAbout143207 NEW BELGIUM BREWING CO - INSURANCE CERTIFICATE (3)Client#: 32611
NEWBE
ACORD,M CERTIFICATE OF LIABILITY INSURANCE
DATE
08/17/05Omrv)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
9351 Grant Street, Suite 600
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Thornton, CO 80229
720 977-7110
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
New Belgium Brewing Company, Inc.
500 Linden St.
Fort Collins, CO 80524
INSURERA: Federal Insurance Company
INSURERS: Pinnacol Assurance
INSURER C:
INSURERD:
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE (MM/DLICY D/YYEOLII
PDATY MWD TION
LIMITS
A
GENERAL LIABILITY
35339782DEN
06/01/05
06/01/06
EACH OCCURRENCE
$1000000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTEDPREMISES (Ea accurrencel
$1 000 000
CLAIMS MADE 51 OCCUR
MED EXP (Any one person)
$1 O 000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
12,000,000
GEN'L AGGREGATE LIMITAPPLIES PER:
PRODUCTS-COMP/OP AGG
$2000000
17 POLICY JECT LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
73236302DEN
06/01105
06/01/06
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
_
$
$
DEDUCTIBLE
$
RETENTION $
1
B
WORKERS COMPENSATION AND
4020276
06/01/05
06/01/06
WCSTATU- OTH-
EEL
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$500OOO
E.L. DISEASE -EA EMPLOYEE
$500,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$500,000
A
OTHER Liquor
35339782DEN
06/01/05
06/01/06
Liability
$1,000,000 Limit
$1,000 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
RE: Tour de Fat, September 24, 2005
The City of Fort Collins and it's employees, the Diamond Peaks Mountain
Bike Patrol and Colorado State University are named as additional Insureds
on liability policies with regards to events of New Belgium Brewing
Company, Inc.
The City of Fort Collins
PO Box 580
Fort Collins, CO 80522
LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL R0_ DAYS WRITTEN
:E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
iE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED
ACORD 25 (2001/08) 1 of 2 #S323RnA1MA177RA
M-ID 0 AC13RD CORPORATION 19RR
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 25s (200`1108) 2 of 2 #S323804/M317764