HomeMy WebLinkAboutSERTOMA INC AND IT'S SUBSIDIARIES - INSURANCE CERTIFICATE"1 ® CERTIFICATE OF LIABILITY INSURANCE 9/1/2011
DATEIMMDDY YY1
1 7/5/2011
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 thefcertifdcate holder is an.ADDITIONAL INSURED, the policy(ies) must be endorsed. If'SUBROGATION IS WAIVED, subject to
the terms and conditions of the policycertain policies may require an endorsement. A statement on this certificate does noiconfer nghts to the " -
certificate holder in lieu of such endorsement(s).. 'I: •. `
PRoouceai. LOCKTON COMPANIES, LLC,I:KANSAS_ CITY- .:..
ONTAC
NAME: ` '• -
PHONE. --'-- --'—
aC NP: "
`-"• `444W. 47THSTREET: SUITE 900t
KANSAS CITY MO 64112-1906
(816) 960-9000
E-0NAa-
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIL p
INSURERA: PHILADELPHIA INDEMNITY INSURANCE
INSURED SERTOMA INC
1080371 AND IT'S SUBSIDIARIES
INSURER B:
INSURER C:
INSURER D:
1912 E. MEYER BLVD
KANSAS CITY MO 64132
INSURER E :
INSURER F :
COVFRAGFS SRRINOT FI CERTIFICATE NUMBER: 10965961 REVISION NUMBER: XXXXXXX
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.
INSR
TR
TYPE OF INSURANCE
ADD
S D
WV
POLICY NUMBER
MMIDPOLIDYBEE
IYYYY
POUCYEXP
MMIDDIYYYY
LIMITS
A
GENERAL LIABILITY
X MMERCIAL GENE ILITY
Y
N
PHPK617405
9/1/2010
9/1/2011
S
DAMAGE TO RENTED
PREMISES (Ea occurrence)
E 100 QQO
MED EXP (Any oneDamon)
CLAIMSMADE X OCCUR
PERSONAL B ADV INJURY
E 1,000,000
GENERAL AGGREGATE
$
GEN•L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
E 2-000,000
X POLICY I „PE 6. �: LOC•'+;.l-.
_A -
:AUTOMOBILE LIABILITY -- =:`� t
._.. ._..E
-N
N�.
PHPK617405 ?
... _... _.
9/1/2010
9/1/2011
LIMIT -
(Ea accident)
- _�-
E
. ;•.:`."'i -"'
.. i
..... .. .. ... ..-.,...
....
— ..-... _�
BODILY INJURY (Per person)
E '
BODILY INJURY Per acddent
..
'
•.
'ALLOWNEO SCHEDULED:.,
AUTOS: +: ;.' ^ 'AUTOS `.
NON -OWNED __.
'X. HIREDAUFOS>.-'X. AUTOS. :--
:..,,
....`
_
.. •..
-
.. 11"
... ,.
"-
--. ..
,S.;, ..
_
PROPERTY DAMAGE !_
E XXXXXXX..
E XXXXXXX
A
X
UMBRELLALIAB
X
OCCUR
N
-N
PH48319760
9/1/2010
9/1/2011
EACH OCCURRENCE
$ 1000000
AGGREGATE
E
EXCESS LIMB
CLAIMS -MADE
DED I X I RETENTIONS 10,000
E xxxxxxx
WORKERS COMPENSATION
AND EMPLOYERS' UASILRY YIN
ANY PROPRIETORIPARTNERIEXECUTNE
NOT APPLICABLE
TORY LIMIT
ER
E.L. EACH ACCIDENT
E xxxxxxx
OFFICERYMEMBER EXCLUDED? ❑
(Mandatory in NH)
NIA
L. DI SEASE-EAEMPLOYEE
E XXXXXXX
If yes, describe under
I DESCRIPTION OF OPERATIONS below
E.L.DISEASE-POLICY LIMIT
$ XXXXXXX
p
I LIQUOR LIABILITY
N
N
I PHPK617401
9/1/2010
9/1/2011
1,000,000 OCCURRENCE
1,000,000 AGGREGATE
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it mom space Is repaired)
THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER. APPLICABLE TO TIE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED.
OVERLAND SERTOMA (CO) 410606 -CITY OF FT COLLINS IS NAMED AS ADDITIONAL INSURED UNDER GENERAL LIABILITY AS THEIR
INTEREST MAY APPEAR WITH RESPECT TO OVERLAND SERTOMA'S BEER BOOTH DURING NEW WEST FEST AUGUST 12-14, 201 L
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
10965961
AUTHORIZED REPRESENTATIVE
CITY OF FT COLLINS
300 LAPORTE AVE
FT COLLINS CO 80524
ACORD 25(2010/05) The ACORD name and logo are r"Istered marks of ACORD-ISA988-2010 AVUFF CORPORATION. All rights reserved