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HomeMy WebLinkAbout113129 FT COLLINS CONVENTION & VISITORS BUREAU - INSURANCE CERTIFICATE7 se
�I CERTIFICATE OF LIABILITY INSURANCE OF FM
DATE(MMIDDM'YY)
06/19/12
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.
-S<
A the certificate holder is an ADDITIONAL INSURED, the po cy es must be endorsed. G , 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 Hour of such endorsement(s).
PRODUCER
NAME:
PHONE
INC, No, Est): (AIC, No):
Blown & BIOwn Inc
ADDRESS:
4532 Boardwalk Dr, Suite 200
Fort Collins CO 80525
CUSTOMERIDS: FCCON-3
Phone:970-482-7747 Fax:970-484-4165
INSURER(S) AFFORDING COVERAGE
WUCi
INSURED I�l_
'/
INSURERA: Ind*smitY ^'P+nY co
25658
Ft Collins Convention
S Visitors Bureau
_Ttavol.ze
INSURER B: Plnnacol Assurance company
41190
1 INSURER C: Ta+velets cas, lty c surety
31194
19 Old Town Square #137
-- Ft Collins CO 80529
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. NOTWITHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Y,[R
TYPE OF INSURANCE
INSR
POLICY NUMBER
(MMIDDIYY'R)
(MMIDOM'W)
LIMITS
AC(
A
GENERALUABILTY
X COMMERCwLGENERAIUABILITY
CI -Ad -MADE O OCCUR
X
26806539H83AINDll
11/01/11
11/01/12
EACH OCCLRRENCE
f 1,000,000
PREMISES IES=.',rlce)
f 300,000
MED EXP (Am, ane person)
$ 5,000
PERSONAL& ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2 , 000 , 000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY PRO JECT LOC
PRODUCTS - COMP/OP AGG
$2,000,000
$
A
--
AUTOMOBILE
LIABILITY
PNY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
BA-217OC947-11-SEL
11/01/11
11/01/12
COMBINED SINGLE LIMIT
(Ee III
$ 1 , OOO , DDD
BODILY INJURY (Per parson)
f
BODILY INJURY (Per accident)
f
X
PROPERTY DAMAGE
(Per sccidant)
$
X
X
$
S
—
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEIXICTIBLE
RETENTION f
$
$
B
AC(
8Cold ENSATION
AND EMPLOYERS' LIABILITY YIN
PNY PROPRIETOR/PARTNEREXECUrIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandetory in NH)
If yes, descnbe under
DESCRIPTION OF OPERATIONS below
/A
196'7062
07/01/12
07/01/13
X TORY LIMITS ER
E. L. EACH ACCIDENT
$100,000
E. L. DISEASE - EA EMPLOYEE
$100,000
E. L. DISEASE -POLICY LIMIT
$500,000
C
Directors/Officers
EPLI
105633862
01/01/12
07/01/13
D60/EPLI 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101. Addttlonal Rems Ms Schedule, B more apace is required)
City of Fort Collins it officers, a4ents, nlo ees and volunteers are
namean
d as Additional insured as it relates to theyAmateur Softball
Associaton on Tuesday, July 31, 2012 - Civic Center Park
lmurray@fcgov.com - Larry Murray
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
FTCRMGT I THE EXPIRATION DATE THEREOF, NOTICE WILL Be DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins AUTHORRED REPRESENTA
Risk Managment
PO Box 580 House Account
reserved
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD