HomeMy WebLinkAboutBEET STREET - INSURANCE CERTIFICATEACQRDT CERTIFICATE OF LIABILITY INSURANCE
'
0DATE 6/15/2009
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4821 Wheaton Drive
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW...,
P O Box 270370
�—
Fort Collins, .CO 80527
INSURERS AFFORDING COVERAGE
NAIC #
INSURED r::! _ •r :i
Beet ;Street -
i" 19, Old Town Square #230
Fort Collins, CO 80524
INSURER A: Philadelphia Insurance.Companie
INSURERB: Darwin Select Insurance Company_
INSURER C:
INSURER D:
INSURER E:
COVFRArF.R
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
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YY
POLICY EXPIRATION
DATE MMIDDIYY
LIMITS
A
GENERAL LIABILITY
PHPK333152
08/01/08
08/01/09
EA CH OCCURRENCE
$1 00Q 000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$100 000
MED EXP (Any one person)
$5, 000
CLAIMS MADE Q OCCUR
PERSONAL & ADV INJURY
$1 00Q 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
PROJECT LOC
F_1POLICYE1
AUTOMOBILE
LIABILITY
ANY AUTO, •
_
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)'
$
ALL.OWNED AUTOS
SCHEDULED AUTOS
-
•• -
BODILY INJURY
(Per accident)
$ ,
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
1
ANY AUTO
F
$
AUTO ONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
X OCCUR ❑ CLAIMS MADE
PHUB246509
08/01/08
08/01/09
EACH OCCURRENCE
$1 000 000
AGGREGATE
$1 000 000
$
DEDUCTIBLE
X RETENTION $ 1U 000 _
$
WORKERS COMPENSATION AND
WC STATU- OTH-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
SPECIAL PROVISIONS below
B
OTHER D & O
03039528
05/20/09
05/20/10
$500,000 Maximum
Liability
$0 Retention
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
The certificate holder is named as an additional insured as their
interest may appear in reference to the named insured's operations.
(Excluding Workers Compensation)
., LAIR r_LI_i I IUN l u ways for non-ra ment
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 . n DAYS WRITTEN
P.O. Box 580 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Fort Collins, CO 80522 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ApU�T-HORIZED REPRESENTATIVE yy--
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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.
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