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HomeMy WebLinkAbout119633 MASEK GOLF CAR COMPANY - INSURANCE CERTIFICATE (4)�Ro® CERTIFICATE OF LIABILITY INSURANCE OP ID NL [--DEATTE(MM/DDMYY) 10/26/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Richard Maxedon C . J . Thomas Company, Inc. kou NAME: _ PHONE A/c, E:t : (AIC, No): IN ADDRESS: 800 Market:.,Stree.t, . 18th Floor rKULMULK CUSTOMERID#: MASEK-1 ._ _ ._ .. .... . St: Louis :MO 631,01 Phone:314-231-1717 Fax:314-231-4482 INSURER(S)AFFORDING COVERAGE: -:"_"'--" INSURED INSURER A: National Fire 20478 Masek Distributing, Inc. New Ports LLC 425 M St building 1 Gering NE 69341 INSURERB: Accident fund Insurance Co. 10166 INSURERC: Continental Insurance 35289 INSURER D: Continental Casualty Company 20443 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rx-1 OCCUR X CNP4012387759 ---.- 11/09/10 - - 11/09/11 -- EACH OCCURRENCE $ 1000000 PREMISES (Eaoccurrence) $ 300000 MED EXP (Any one person) $ 10000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE" $ 2000000 .. GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT PRODUCTS =COMP/OP AGG- $2000000 - $- -- C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS = SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X BUA4012387731 11/09/10 11/09/11 COMBINED.SINGLE LIMIT (Ea accident) $ 1000000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ D UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE B4012387762 11/09/10 11/09/11 EACH OCCURRENCE $ 1000000 AGGREGATE $ 1000000 DEDUCTIBLE RETENTION $ 10000 $ X $ B - WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIV� OFFICERIMEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below /A WCV60503 11/09/10 11/09/11 X - I- TORY LIMITS ER E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE - POLICY LIMIT $ 500000 D Equipment Floater IM4012163258 11/09/10 11/09/11 Golf Car $2 , 700 , 000 Ded $2,500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES {Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYOFF I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD