HomeMy WebLinkAbout129790 THE FEET INC - INSURANCE CERTIFICATE (5)From: Ton Griscavage At: Brown & Brown of Colorado READ: (970) 484-4165 To: Oty of Fort Collins
Date: 6/302011 01:48 PM Page: 1 of 1
A OR� CERTIFICATE OF LIABILITY INSURANCE OPID TG
DA 06/3DIYIIY)
06/30/11
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 A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder Is an ADDITIONAL INSURED, the poi cy(es) 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
NAMEPHONE
(A/C, No. Erry: (AIC, No):
Brown S BIown Inc
ADDRESS:
4532 Boardwalk Dr, Suite 200
Fort Collins CO 80525
CUSTOMERIDk FEET-01
Phone:970-482-7747 Fax:970-484-4165
INSURER(S) AFFORDING COVERAGE
NAIL#
INSURED
INSURER A: Mountain States Mutual
14648
The Feet, Inc.
Velocity BoyYs, Inc. dba:
INSURER B: AGCS Marine Insurance Co.
22837
INSURER C: Pinnacol Assurance
41190
622 Sherry Dr.
Fort Collins CO 80524
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. NOTNITiSTANDING ANY REQUIREMENT, TERM OR CONDITION OF MY 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
WVE
POLICY NUMBER
(MMIDD)YYYY)
(MMIDDrOOO)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X COMMERCIAL GENERAL LNBILIW
CPPOI0129608
07/01/11
07/01/12
PREMISESEeocwvence)
$100,000
CLAMS-M,DE O OCCUR
MED EXP (Any ona parson)
$ 10,000
PERSONAL& ADV INJURY
$ 1 , 000, 000
X
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMPIOP AGO
s2,000,000
POLICY PEO LOC
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ed eccl dent)
$1,DDD,DDD
A
X
ANY AUTO
BAP010129608
07/01/11
07/01/12
BODILY INJURY (Per person)
$
ALL OWNED Auros
BODILY INJURY (Per academy
$
SCHEDULED AUTOS
HIREDAIJTOS
PROPERTY DAMAGE
(Per accident)
$
NWOWNED AUTOS
$
A
UMBRELLA LIAR
i X
OCCUR
UMB010129606
07/01/11
07/01/12
EACH OCCURRENCE
$1,000,000
EXCESS LWB
CLAIMS -MADE
AGGREGATE
I 9 1,000,000
DEDUCTIBLE
Is
$
X
RETENTION $ 0
C
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIErORIPARTNER/EXECl1TIVE I
OFFICERIMEMBEREXGLIA M fl
NI,
07/01/11
07/01/12
X TORY LIMITS VER
EL. EACHACCIDENT
$ 1000000
EL. DISEASE - EA EMPLOYEE
$ LDDDDDU
(Mandatory in NH)
It yes, dewnhe under
E.L. DISEASE -POLICY LIMIT
$1000000
DESCRIPTION OF OPERATIONS Cel<m
B
Trans/Motor Truck
MZI98470793
02/15/11
02/15/12'
Limit $100,000
Caro
I
Ded $1,000
DESCRIPTION OF OPERATIONS I LOCATONS I VEHICLES (Attach ACORD 101, Addtlonal Remark. Schedule, If more apece Is required)
City of Fort Collins is included as Additional Insured with respects to
General Liability.
Fax H221-6707
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYDIV THE EXPIRA -ON DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
Purchasing Division AUTHORIZED REPRESENTATIVE
Attn: Jim Hume
PO Box 580
(Fort Collins CO 80522-0580 Tyler B. Allen
reserved,
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD