HomeMy WebLinkAboutROLEXIS DBA TEAM SPORT PHOTO STUDIO - INSURANCE CERTIFICATESENTRY INSURANCE A MUTUAL COMPANY
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
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CERTIFICATE OF INSURANCE
ACCOUNT NUMBER 49-99863
This certificate is issued as a matter of information only and confers no
rights upon the certificate holder. This certificate does not amend,
extend or alter the coverage afforded by the policies below.
Name and Address of
Certificate Holder
CITY OF FORT COLLINS
215 N MASON ST 2ND FLR
PO BOX 580
FORT COLLINS, CO 80522
Name and Address
of the Insured
ROLEXIS DBA
TEAM SPORT PHOTO STUDIO 2000
1188.0 UPHAM ST, UNIT A
BROOMFIELD, CO 80020
This certificate is issued on 09-08-2010 and is effective until
01-01-2011. It certifies that policies of insurance listed below have
been issued to the insured named above. 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. Limits shown may have been reduced by
paid claims.
Coverage Provided Policy
Number Coverage
Limits
Businessowners Liability 49-99863-01 Each Occurrence
$
11000,000
Medical Expense
$
10,000
Includes: Bodily Injury
Damage to Premises
$
100,000
Property Damage
General Aggregate
$
31000,000
Personal Injury
Products Aggregate
$
31000,000
Hired and Non -Owned Auto
If any of the listed policies are cancelled prior to their normal
expiration date, the insurer will send notice to the certificate
holder 10 days in advance.
80-C1035 (MECH)
TEA 49-99863 31-060501
09-08-2010
PAGE 1
(0009) OITIBORG 05208
SENTRY INSURANCE_ A MUTUAL COMPANY SENTRY'S BUSINESSOWNERS
STEVENS POINT, WISCONSIN POLICY
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
POLICY NUMBER 49-99863-01
NAME INSURED: ROLEXIS DBA
ADDITIONAL INSURED
SCHEDULE
The following information is required to complete the accompanying
additional insured endorsement which forms a part of the Named Insured's
BUSINESSOWNERS POLICY.
ADDITIONAL
INSURED ENDORSEMENT EFFECTIVE
CITY OF FORT COLLINS BP 04 50 01 06 FROM SEPTEMBER 08, 2010
215 N MASON ST 2ND FLR TO JANUARY 01, 2011
PO BOX 580
FORT COLLINS, CO 80522
(CERTIFICATE NUMBER 0009)
LOCATION(S) OF COVERED OPERATIONS
215 N MASON ST 2ND FL
FORT COLLINS, CO 80522
JOB: ON SITE TO TAKE PICTURES
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FOR ENDORSEMENT TEXT,
SEE OVER.
0 BP 89 05 01 87 (MECH)
TEA 49-99863-01 00 101
09-08-2010
(000 0009)
05213
OIT10ORG
ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
The following is added to Paragraph C. WHO IS AN INSURED in SECTION II - LIABILITY:
3. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused; in whole or in part, by:
a. Your acts or omissions; or
b. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s)
designated above.
With respect to the insurance afforded to these additional insureds, the following additional exclusions
apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
a. All work, including materials, parts or equipment furnished in connection with such work, on the
project (other than service; maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered operations has been completed; or
b. That portion of "your work' out of which the injury or damage arises has been put to its intended
use by any person or organization other than another contractor or subcontractor engaged in
performing operations for a principal as a part of the same project.
BP 04 50 01 06
Copyright, ISO Properties, Inc., 2005
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