HomeMy WebLinkAboutYOUTH ORCHESTRA OF THE ROCKIES ASSO. - INSURANCE CERTIFICATERom® CERTIFICATE OF LIABILITY INSURANCE OP ID LD DATE(MMIDDM/YY)
05/20/11
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 ACONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: if the certificate holder is an ADDITIONAL R , the poli ies must be endorsed. If SUBROGATIONIS 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
Brown 6 Brown Inc
NAME:
PHONE FAX
125 S Howes, 5th Floor
(EaC,No,Ext): (A/C, No):
ADDRESS:
P O Box 2226
Fort Collins CO 80522-2226
PRODUCEM
aisERIDa: YOUTH-1
Phone:970-482-7747 Fax:970-484-4165
INSURER(S) AFFORDING COVERAGE
NAIC0
INSURED
INSURER A: P1nnacol Assurance Company
41190
Youth Orchestra of the
Rockies Association
INSURERB:
INSURERC:
P.O. BOX 270396
Ft Collins CO 80527
INSURER D
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.
INRI T—
R
TYPE OF INSURANCE
INSR
WVD�
POLICY NUMBER
(MM UDC)
POLICY UP
(MMIDOM/YY)
LIMBS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLPJMS-MADE OCCUR
EACH OCCURRENCE
$
PREMISEE SFa occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEHL AGGREGATE LIMIT APPLIES PER
POLICY n PRO-
JECT n LOC
PRODUCTS -COMP/OP AGG
$
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
UMBRELLA LIAR
EXCES$LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $.
$
$
A
WORKERS COMPENSATION
AND EMPLOVER5 LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECLFFNn
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
N yes describe under
DESCRIPTION OF OPERATIONS below
NIA
402 9 B
06/01/11
06/01/12
X
TORV LIMBS ER
E.L EACH ACCIDENT
$ 100000
EL DISEASE - EA EMPLOYE
$ 100000
E.L DISEASE - POLICY LIMIT I
$ 500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more apace Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYFIO I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
215 N. Mason St.
Fort Collins CO 80521
di reSerVPd
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD