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HomeMy WebLinkAbout119633 MASEK GOLF CARS OF COLORADO - INSURANCE CERTIFICATEMASEK-1 OP ID: NL ,411. z CERTIFICATE OF LIABILITY INSURANCE DAT12106DVYYY) 2106112 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 doesnot confer -rights to the certificate holder in lieu of such endorsement(s). PRODUCER • .,-- ; - 314-231-1717 Richard Maxedon -:. ---- - - '- C.J. Thomas Company; Inc,_, 1�r 1 314-231-4482 800 Market Stretl 18th Floor St. Louis, MO 63101 - -- -- NAMEACT PHONE E.0: FAX No: E"MAIL ADDRESS: Richard Maxedon INSURER(S) AFFORDING COVERAGE NAICN INSURER A:Accident Fund Insurance Co. 10166 INSURED Masek Distributing, Inc. Masek Rocky Mountain Distribution, Inc. dba Masek - INSURER B: INSURER C: INSURER D: Golf Cars of Col d 4 St ullding 1 Gering, NE 69341 INSURER E NSURER FF COVERAGES CERTIFICATE NUMBER: REVISIONNUMBER: 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 TYPEOF INSURANCE IN SR SI-1liR POLICY NUMBER V MMIDD/YYYY MM/OD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS -MADE ❑ OCCUR MED EXP(Anyoneperson) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMPIOPAGG $ " $ POLICY .. . .PRO"'."' LOC ,. ._ " A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED ' 'SCHEDULED ' AUTOS AUTOS - _ 1 BODILY INJURY (Per accident) $- _ PROPERTY DAMAGE' Per accident $. ' NON -OWNED HIRED AUTOS AUTOS — - _ - $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ $ EXCESS LIAB CLAIMSMADEAGGREGATE DED RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA WCV6050318 11109/12 11109/13 X WC STATU- OTH- RY LIMITS E EL EACH ACCIDENT $ 600,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,00 7 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CITYOFF City of Ft Collins Attn: Jim Hume P.O. Box 580 215 N. Mason St 2nd Floor Ft. Collins, CO 80522-0580 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 1ST ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010106) The ACORD name and logo are registered marks of ACORD