HomeMy WebLinkAboutYOUTH ORCHESTRA OF THE ROCKIES ASSO - INSURANCE CERTIFICATEA
OK� CERTIFICATE OF LIABILITY INSURANCE OF ID SMS DATE05/DDTY1
05 21/12
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(ies) 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
NAME:
Blown & Blown Inc
PH NE
No Exq: I (A/C, No):
_IAIC
ADDRESS:
4532 Boardwalk Dr, Suite 200
Fort Collins CO 80525
PRODOCER
CUSTOMER ID p: YOUTH-1
Phone:970-482-7747 Fax:970-484-4165
INSURER(S) AFFORDING COVERAGE
NAICN
INSURED
INSURER A: Pinnacol Assurance Company
41190
Youth Orchestra of the
Rockies Association
INSURER B:
INSURER C:
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,
INSR
LTR
TYPE OFINSURANLE
ADDUSUBR
INSR
WVD: POLICY NUMBER
DDCV EFFTTPOLICPERP
(MMIDDIYYYYI
(I DIYYYY)
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITTE
TY
CLAIMS -MADE 7OCCUR
EACH OCCURRENCE
OAMAGETO REI
PREMISES (Ea occurrence)
$
$
MED EXP(My one person)
$
PERSONALS ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY n PRO-JECT n LOC
PRODUCTS - COMP/OP AGG
$
AUTOMOBILE
LIABILITY
ANYAUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-0W NED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per perm)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAR
EXCESS LIAB
OCCUR
GtAIMS-MADE
EACN OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
g
g
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETORIPARTNER/EXECUTIyB�
OFFICER(MEMBER EXCLUDED?
(Mandatory In NH) u
If year, descries under
DESCRIPTION OF OPERATIONS Below
N/A
4029998
os/oi/La
06 /O1/13
- TH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$ 100000
E.L. DISEASE-EAEMPLOYEE.$1DDDDD
EL DISEASEPOLICV LIMIT
$500000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required)
CERTIFICATE HOLDER CANCELLATION
CITYF10 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
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
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD