HomeMy WebLinkAboutFORT COLLINS VEL - INSURANCE CERTIFICATEClient#: 49249
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ACORD CERTIFICATE OF LIABILITY INSURANCE
D07/012011ATE YY
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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(les) must be endorsed. It 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
Flood & Peterson Ins., Inc.
P. O. Box 578
CONTACT
NAME:
PHONE g70 356-0123 9703301867
A/C No Ell : A/C, No
rU
Greeley, CO 80632
970356-0123
ADDRESS:
CUSTOMER ID a:
INSURER(S)AFFORDING COVERAGE
NAIC0
INSURED
Fort Collins Velodrome Association
INSURER A: Philadelphia Insurance Companie
1115 Club View Terrace
INSURER B:
Fort Collins, CO 80524
INSURER C
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 CONTRACTOR 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.
LTjL
TYPE OF INSURANCE
POLICY NUMBER
MM%DONYY
MWDONYP
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
PHPK736573
6/16/2011
12/31/2011
EACH OCCURRENCE
$1000000
FIE
PREMISES Eaoccurrome
$100000
MED EXP (Any me person)
so
PERSONAL& ADV INJURY
$1,000000-
GENERALAGGREGATE
$3,000,000
GEN'L AGGREGATE
POLICY
UMrT APPLIES PER:
0. LOC
72
PRODUCTS - COMP/OP AGO
$3,000,000
$
AUTOMOBILE
LIABIL"
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per attitlent)
$
PROPERTY DAMAGE
(Per accident)
S
$
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CIAIMS MAIE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION
$
$
WORKERS COMPENSATION
ANDEMPLOYERS' LIABILITY YIN
ANY PROPRIETOWPARTNERIEXECUDVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yyes. describe under
DESCRIPTION OF OPERATIONS below
N/A
WC STATU- OTH-
tTOLIMITSI ER
E.L EACH ACCIDENT
$
E.L DISEASE - EA EMPLOYEE
$
E.L. DISEASE -POLICY LIMIT
$
A
Directors &
Officers
PHSD622353
6/16/2011
12/31/201
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required)
Re: City Street Crits
City of Fort Collins and Ciclismo Youth Foundation are is named as additional insured.
City of Fort Collins
300 LaPorte Ave.
Fort Collins, CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
F/O,Ck T AA-tfi."SoAj , INC.
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) 1 Of 1
#S627111/M627106
The ACORD name and logo are registered marks of ACORD
PXC