HomeMy WebLinkAboutROLEXIS DBA TEAM SPORT PHOTO STUDIO - INSURANCE CERTIFICATE (2)SENTRY INSURANCE A MUTUAL COMPANY
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
aCERTIFICATE OF INSURANCE ACCOUNT NUMBER 49-99863
This certificate is issued as a matter of information only and confers no
rights upon the certificate holder. This certificate does not amend,
extend or alter the coverage afforded by the policies below.
Name and Address of Name and Address
Certificate Holder of the Insured
CITY OF FORT COLLINS ROLEXIS DBA
215 N MASON ST 2ND FLR TEAM SPORT PHOTO STUDIO 2000
PO BOX 580 11880 UPHAM ST, UNIT A
FORT COLLINS, CO 80522 BROOMFIELD, CO 80020
This certificate is issued on 01-01-2012 and is effective until
01-0.1-2013. It certifies that policies of insurance listed below have
been issued to the insured named above. 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.
Coverage Provided
Policy Number Coverage
Limits
Businessowners Liability
49-99863-01 Each Occurrence
S
1,000,000
Medical Expense
$
10,000
Includes: Bodily Injury
Damage to Premises
$
100,000
Property Damage
General Aggregate
$
3,000,000
Personal Injury
Products Aggregate
S
3,000,000
Hired and Non -Owned
•
Auto
Should any of the above
described policies be cancelled before
the
expiration date thereof,
notice will be delivered in accordance
with the policy provisions.
• 80-C1035 (MECH)
TEA 49-99863 31-060501
11-08-2011
PAGE .1
(0009)
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SENTRY INSURANCE A MUTUAL COMPANY SENTRY'S BUSINESSOWNERS
STEVENS POINT, WISCONSIN POLICY
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
is
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NAME INSURED: ROLEXIS DBA
ADDITIONAL INSURED
SCHEDULE
POLICY NUMBER 49-99863-01
The following information is required to complete the accompanying
additional insured endorsement which forms a part of the Named Insured's
BUSINESSOWNERS POLICY.
ADDITIONAL
INSURED ENDORSEMENT
CITY OF FORT COLLINS BP 14 65 06 10
215 N MASON ST 2ND FLR
PO BOX 580
FORT COLLINS, CO 80522
(CERTIFICATE NUMBER 0009)
LOCATION(S) OF COVERED OPERATIONS
215 N MASON ST 2ND FL
FORT COLLINS, CO 80522
JOB: ON SITE TO TAKE PICTURES
FOR ENDORSEMENT TEXT,
SEE OVER.
BP 89 05 01 87 (MECH)
TEA 49-99863-01 00 121
11-OB-2011
(000 0009)
EFFECTIVE
FROM JANUARY 01, 2012
TO JANUARY 01, 2013
01 TIHORG 03769