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HomeMy WebLinkAbout119633 MASEK GOLF CAR COMPANY - INSURANCE CERTIFICATE (3)�Rn CERTIFICATE OF LIABILITY INSURANCE OPID DM DATE(MMI6/ PRODUCER MASEK-1 11/06/09 09 Richard Maxedon THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION C.J. Thomas Company, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 NAIL# INSURED INSURER A: National Fire 20478 Masek Distributing, Inc. NsuRERe: Continental Insurance 35289 New Ports LLC 425 M St building 1 INSURER Continental casualty Company 20443 Gering NE 69341 INSURER Accitlant Fend insarance co. _ 10166 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. INS l'J __... — --- "ER LTR TYPE OF INSURANCE POLICY NUMBER NODCY tPFE7;YICre DATE MM/DD/VYYY P�CICIr€XPITA71b DATE MMJDDr(YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 X A X COMMERCIAL GENERAL LIABILITY CNP4012387759 11/09/09 11/09/10 PREMISES'ES(eaoENTEcureeoce) s 300000 MED EXP(Any CLAIMS MADE C� OCCUR one person) $ 10000 PERSONAL &ADV INJURY $ 1000000 GENERALAGGREGATE $ 2000000 ---- ---.. GEN'L AGGREGA- PER PRODUCTS - COMP/OP AGG --- $2000000 PROTAPPLIES X POLICY PRO- JECT LOC ___ AUTOMOBILE LIABILITY —'-- '-- B X ANY Auro BUA4012387731 11/09/09 11/09/10 COMBINED SINGLE LIMIT (Ea accident) -- $ 100QQQQ X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) ---- $ HIRED AUTOS — NON -OWNED AUTOS ODILiINJU Bar acci ent) $ PROPERTY DAMAGE $ --"—'- (Per accident) GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/ LIABILITY C ,jOCCUR CLAIMS EACHOCCURRENCE 10 S(0000 X] u MADE CUP4012387762 11/09/09 11/09/10 AGGREGATE S ],0000QQ DEDUCTIBLE ------"-- X RETENTION $10000 l"JORi(ERF COMPENSATION AND EMPLOYERS' LIABILITY Y/N X TORV LIMIT ER $ D ANY PROPRIETOR/PARTNER/EXECUTIV WCV6050318 11/09/09 11 OFFICER/MEMBER EXCLUDED? /09/10 E.L. EACH ACCIDENT $ 500000 Mandatory in NH) _ yyes, describe E.L. DISEASE-EA EMPLOYEE $500000 S PROVISIONS OTHERLPROVISIONSbelow OTHER _ E.L. DISEASE - POLICY LIMIT s500000 C Equipment Floater IM4012163258 11/09/09 11/09/10 Golf Cars $2167000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ Deductibl $2,500 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. CFRTIFICATF 1-1n1 nFIO SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI, CITYOFF DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City Of Ft Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn: Jim Hume P.O. BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 215 N. Mason St 2nd Floor REPRESENTATIVES. Ft. Collins CO 80522-0580 ORIZED �EPRES�NTATIV� 25 (2009/01) - ©1988-2009 ACORD CORPORATION. All rights reserved. 1 11v „a umu name ana logo are registered marks of ACORD