HomeMy WebLinkAbout119633 MASEK GOLF CAR COMPANY - INSURANCE CERTIFICATEOP ID NL DATE (MM/DDYYY)
ACORD CERTIFICATE OF LIABILITY INSURANCE MASEK-1 02 03/Y09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Richard Maxedon ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
C.J. Thomas Company, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
800 Market Street, 18th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
St. Louis MO 63101 -
Phone: 314-231-1717 Fax•: 314-231-4482 - INSURERS AFFORDING COVERAGE-- - NAIC #
INSURED INSURER A: National Fire. `"t' "-20478------
INSURER B: Continental' In8LlranCe 35289
Mas'ek.'Distributing'., .Inc..... wsuRERC: A��ident Tuna �nsu=a�ce'co. ZOY66
New PortsLLC --
425 -M- St Auilding 1 INSURER D: Continental Casualty Company 20443
Gering NE 69341
-- INSURER E: ` - -. - ._- -- - -- - - -- ------ ----- •------
COVERAGE5 -
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
DATEYMM/DD/YY E
ON
PDATEY MM/DD/YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X
X COMMERCIAL GENERAL LIABILITY
CNP4012387759
11/09/08
11/09/09
PREMISES(Eaoccurence)
$ 300,000
CLAIMS MADE Fx_� OCCUR
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2 , 000 , 000
PROJECT LOC
X POLICY I
B
X
AUTOMOBILE
LIABILITY
ANY AUTO
BUA4012387731
11/09/08
11/09/09
COMBINED SINGLE LIMIT
(Ea accident)
$ 1 000 000
� i
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident) .
-$.. .... ..... .. ..
Y
'
HIRED AUTOS
NON -OWNED AUTOS
- -
PROPERTY DAMAGE
(Per accident) --
$
-
-
GARAGE LIABILITY "'
-
- -
AUTO ONLY = EA -ACCIDENT`
$ -
_ - -- -. ._-- -- EA ACC
OTHER THAN
$ -. _.. . _..
ANY AUTO
. -
-
$ _
-
AUTO ONLY: -AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$1,000,000
D
X OCCUR El CLAIMS MADE
CUP4012387762
11/09/08
11/09/09
AGGREGATE
$ 1 , 000 , 000
$
RDEDUCTIBLE
$
X RETENTION $ 10000
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
WCV6050318-0
11/09/08
11/09/09
X TORY LIMITS ER
E.L. EACH ACCIDENT
$500 000
E.L. DISEASE - EA EMPLOYEE
-—
s500,000
E.L. DISEASE - POLICY LIMIT
$ 500 , 000
OTHER
D
Equipment Floater
IM4012163258
11/09/08
11/09/09
Golf Cars $2,167,000
Ded. $2,500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Ft. Collins, its officers, agents and employees are included as
additional insured in regards to the auto liability and general liability in
regards to the contract with the named insured.
CERTIFICATE HOLDER CANCELLATION
City of Ft Collins
Attn: Jim Hume
P.O. Box 580
215 N. Mason St 2nd Floor
Ft. Collins CO 80522-0580
CITYOFF 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.
9
AI,UKU ZO (LUUI/Ut)) 9 ACORD CORPORATION 1988