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HomeMy WebLinkAboutLEWIS TENNIS LLC - INSURANCE CERTIFICATE (6)To: Page 2 of 3 2012-06-15 12:16:10 MST 18664607066 From: JDella Cox H I.VRL/, CERTIFICATE OF LIABILITY INSURANCE 06/15/2012 06 15/2012 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 holtler iS an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION IS WAIVED, s,Ajectto 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 Ewing -Leavitt Insurance Agency 4025 St. Cloud Dr. Suite 100 Loveland, CO 90538 CONTACT NAME: ?,"c N„ E,,, 970.679. 7333 FAX, N,: 866.456.4265 E-MAIL ADDRESS: PRODE I 'USTUCER 000OS796 INSURER(S) AFFORDING COVE RA GE MICE INSURED Lewis Tennis LLC 1205 W Elizabeth ST. HPN6111 Fort Collins, CO SOS21 INSURER A: Auto Owners- 18988 INSURER B: INSURER C: INSURER D: INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 12-13 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 OF INSURANCE PDDL INSR SUBR WVD POLICY NUMBER POLICY EFF MWDDIYYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY 74697368-1 07/15/2012 07/15/2013 EACHOCCURRENCE $ I 000OO X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurured.1 $ 50,00 CLAIMSMADE OCCUR MED EXP(Any one person) $ 5,00 A X PERSONAL & ADV INJURY $ 1, 000, OO GENERAL AGGREGATE $ 2, DOC GEHL AGGREGATELIMfT APPLIES PER. PRODUCTS COMPIOPAGG $ 2, 000, DO POLICY PRO- LOC ECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E. accident) $ ANY AUTO GODLY INJURY (Per person) $ ALI. OWNED AUTOS GODLY INJURY (Per accdent) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ NON OWNED AUTOS $ 8 UMBRELLA LIAB OCCUR EACH OCCUR PENCE $ OF $ EXCESS LIAB CLAtMSMADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN H- I TORYLIMITS ER E L. EACH ACCIDENT 8 ANY PROPRIETORPARTNEIVExECUTIVE❑ OFFICERIMEMBER EXCLUDED9 NIA E L. DISEASE - EAEMPLOYE $ (Mandatory In NH) I es, describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES VIY.th ACORD 101. AddiNenL RrmarFF SdhoLulr, If moro rPat. it .,.i,.d) City of Fort Collins is named as an Additional Insured. CERTIFICATE HOLDER CANCELLATION FAX: 970.221.6782 City of Fort Collins PO Box S80 Fort Collins, CO 80522 ACORD 25 (2009109) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE +11AI It The ACORD name and logo are registered marks of ACORD RATION All rinhfc mcnrvad To: Page 3 of 3 2012-06-15 12:16: 10 MST 18664607066 From: Joella Cox Agency Code 32-0043-00 Policy Number 044632-74687368 COMMERCIAL GENERAL LIABILITY 55202 (12-04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED EXCLUSION - PRODUCTS -COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization (Additional Insured): CITY OF FORT COLLINS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Under SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- ITY, 2. Exclusions, the following exclusion is added: 2. Exclusions This insurance does not apply to: The limits of liability for the Additional Insured are those specified in the written contract or agreement between the insured and the owner, lessee or con- tractor, not to exceed the limits provided in this policy. These limits are inclusive of and not in ad- dition to the limits of insurance shown in the Decla- rations. The Additional Insured for the "products-com- D. Under SECTION IV - COMMERCIAL GENERAL LI- pleted operations hazard". ABILITY CONDITIONS, 4. Other Insurance, the fol- B. Under SECTION II - WHO IS AN INSURED, the fol- lowing is added: lowing is added: The person or organization shown in the above Schedule is an Additional Insured, but only with re- spect to liability arising out of "your work" for that Insured by or for you. C. Under SECTION III - LIMITS OF INSURANCE, the following is added: This insurance is primary for the person or organ- ization shown in the Schedule, but only with respect to liability arising out of "your work" for that person or organization by or for you. Other insurance available to the person or organization shown in the Schedule will apply as excess insurance and not contribute as primary insurance to the insurance provided by this endorsement. Includes copyrighted material of Insurance Services Office., Inc., with its permission. Copyright, Insurance Services Office, Inc., 1984, 2003. Page 1 of 1 To: Page 1 of 3 2012-06-15 12:16: 10 MST 18664607066 From: Joella Cox FAX COVER SHEET TO COMPANY FAX NUMBER 19702216782 FROM Joella Cox DATE 2012-06-15 12:15:51 MST RE Certificate for Lewis Tennis/ City of Fort Collins COVER MESSAGE Please see attached certificate. Let me know if you have any questions or need any changes. Thank you, Joella Cox Ewing Leavitt Insurance 888 243 1611 cicewing@leavitt.com This email contains information that may be confidential and proprietary. If you are not the intended recipient, please delete this email and notify me immediately. WWW.EFAX.COM