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HomeMy WebLinkAboutFOOTHILLS GATEWAY INC - INSURANCE CERTIFICATE (5)Client#: 37379
FOOGA
ACOI CERTIFICATE OF LIABILITY INSURANCE
D
06/061DOIYYYY)
s/os/zola
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 endomement(s).
PRODUCER
NAME: Kelly Beauvais
Flood & Peterson Ins., Inc.
Co Ell; -(Al,IC No): 506-6846
P. O. Box 578
ADDRESS: KBeauvais@floodpeterson.com
Greeley, CO 80632
INSURERISI AFFORDING COVERAGE
NAICM
970 356-0123
INSURER A: Philadelphia Insurance Companie
INSURED
INSURER B: Plnnacol Assurance
Foothills Gateway, Inc.
301 West Skyway Drive
INSURER C
Fort Collins, CO 80525
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 THEz
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTRR
TYPE OF INSURANCE
NSRADDLSUBR
WVD
POLICY NUMBER
POLICY EFF
MMDpYEXP
LIMIT
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
PHPK1185640
7101/2014
07/01/201
EACH OCCURRENCE
PREMISES�soccu ante
NED EXP (Anyone person)
PERSONAL & ADV INJURY
$1 000 000
GENERAL AGGREGATE
s3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER'.
X POLICY PRO- LOC
JECTA
PRODUCTS - COMPIOP AGG
s3,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIRED AUTOS X NON -OWNED
AUTOS
PHPKII85640
0710112014071011201
EOMaBINEEDISINGLELIMIT
$1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)$
X
PROPERTY DAMAGE
Per accident
$
A
X
UMBRELLA LIAB
EXCESS LMB
X
OCCUR
CLAIMS -MADE
PHUB461788
7101/2014
0710112016
EACH OCCURRENCE
$2000000
AGGREGATE
s2,000,000
OED X RETENTION $10 000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED' ❑
(Mandatory in NH)
u yea, deamhe under
DESCRIPTION OF OPERATIONS below
NIA
703552
7/01/2014
07/01/201E
X WCSTAMli OTH-
EL EACH ACCIDENT
$500000
E.L. DISEASE - EA EMPLOYEE
$500000
E.L. DISEASE - POLICY LIMIT
$500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
RE: Flying Pig Charity Run/Walk Fundraiser, April 6, 2014
Certificate holder, its officers, employees and agents are named as additional insured.
City of Fort Collins
PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2010105) 1 Of 1
#S897284/M897279
01988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD