HomeMy WebLinkAbout282740 SPORT & FITNESS INC - INSURANCE CERTIFICATE (3)®Allstate.
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CERTIFICATE OF INSURANCE
Cl CW A02 10 11
This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued
to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided
by such policies. Alteration of this certificate does not change the terns, exclusions or conditions of such policies. Coverage
is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other
contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at
the policy inception. Subsequent paid claims may reduce these limits.
Certificate Holder. Named Insured:
CITY OF FORT COLLINS SPORT AND FITNESS, INC
PO BOX 580 1409 PIKES PEAK AVE
FORT COLLINS, CO USA BOS220580 FORT COLLINS CO 80524-4313
Automobile Liability
Insurer Name: Allstate Insurance Company
Po rNumber. 648128822
1 --Any Auto
2 - Owned Autos Only
3 - Owned Priv. Pass. Autos Only
4 -- Owned Autos Other Than Priv.
Pass. Autos Only
5 - Owned Autos Subject to
No Fault
6 - Owned Autos Subject to a Compulsory UM Law
X
7 -- S ecifically Described Autos
X
8 - Hired Autos Only
9 - Nonowned Autos Only
Policy Effective Date: 12-17-2013
1 Policy Expiration Date: 12-17-2014
Limits of
$1, 000, 000
Combined Single Limit (each accident)
Insurance:
BI Per Person
I BI Per Accident PD Per Accident
Description of O rations/Locations/Vehicles/Endorsements/S dal Provisions
Interested Pa T : Additional Insured - Municipality
THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER.
IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST
EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL
INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH
POLICY LANGUAGE OR ENDORSEMENT.
Producer.
OLD TOWN INS INC
Authorized Representative:
Data:
Includes copyrighted material of Insurance Services Office, Inc., with its permission
au114R-3 Cl CW A02 10 11
Allstate Insurance Company
Additional Insured Copy
Page 1 of 1
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POLICY NUMBER: 648128822
COMMERCIAL AUTO
CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGECOVERAGEFORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured
Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is
indicated below.
Endorsement Effective: 11-24-2014 Countersigned By:
Named Insured:
SPORT AND FITNESS, INC Authorized Representative)
SCHEDULE
Name of Person(s) or Organization(s):
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS, CO USA 805220580
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to the endorsement.)
Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent
that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained
in Section II of the Coverage Form.
0
9D714R-3 CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑
Additional Insured Copy