HomeMy WebLinkAboutROLEXIS INC DBA TEAM SPORT PHOTO - INSURANCE CERTIFICATE (2)SENTRY INSURANCE A MUTUAL COMPANY
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
CERTIFICATE 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
Certificate Holder
CITY OF FORT COLLINS
PO BOX 580
215 N MASON ST 2ND FL
FORT COLLINS, CO 80522
Name and Address
of the Insured
ROLEXIS INC DBA
TEAM SPORT PHOTO
11880 UPHAM ST UNIT A
BROOMFIELD, CO 80020
This certificate is issued on 01-01-2014 and is effective until
01-01-2015. 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
s
300,000
Property Damage
General
Aggregate
$
31000,000
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
10-29-2013
PAGE 1
(0010)
LDI COI 269628-1 02 11
01198
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
POLICY NUMBER 49-99863-01
NAME INSURED: ROLEXIS INC DBA
TEAM SPORT PHOTO
ADDITIONAL INSURED
SCHEDULE
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 04 50 07 13
PO BOX 580
215 N MASON ST 2ND FL
FORT COLLINS, CO 80522
(CERTIFICATE NUMBER 0010)
LOCATION(S) OF COVERED OPERATIONS
CITY OF FORT COLLINS
PO BOX 580
215 N MASON ST 2ND FL
FORT COLLINS, CO 80522
JOB: GOING ONSITE TO TAKE PHOTOS
FOR ENDORSEMENT TEXT,
SEE OVER.
BP 89 05 01 87 (MECH)
TEA 49-99863-01 00 141
10-29-2013
(000 0010)
EFFECTIVE
FROM JANUARY 01, 2014
TO JANUARY 01, 2015
01230
Il01INO 'd►l9uI.,]A0
BUSINESSOWNERS
BP 04 50 07 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS - SCHEDULED PERSON
OR ORGANIZATION
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
SCHEDULE
Name Of Additional Insured
Person(s) Or Orglanization(s) Location(s) Of Covered Operations
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II - Liability is amended as follows:
A. The following is added to Paragraph C. Who Is
An Insured:
3. Any person(s) or organization(s) shown in
the Schedule is also an additional insured,
but only with respect to liability for "bodily
injury", "property damage" or "personal and
advertising injury" caused, in whole or in
part, by:
a. Your acts or omissions; or
b. The acts or omissions of those acting on
your behalf;
in the performance of your ongoing
operations for the additional insured(s) at the
location(s) designated above.
However:
a. The insurance afforded to such additional
insured only applies to the extent
permitted by law; and
b. If coverage provided to the additional
insured is required by a contract or
agreement, the insurance afforded to
such additional insured will not be
broader than that which you are required
by the contract or agreement to provide
for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury"
or "property damage" occurring after:
1. All work, including materials, parts or
equipment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by
or on behalf of the additional insured(s) at
the location of the covered operations has
been completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or
subcontractor engaged in performing
operations for a principal as a part of the
same project.
BP 04 50 07 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 2
GII itlIBL
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Paragraph D. Liability And Medical Expenses
Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most
we will pay on behalf of the additional insured is
the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits Of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits Of Insurance shown in the
Declarations.
BP 04 50 07 13 Copyright, Insurance Services Office, Inc., 2012 Page 2 of 2