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HomeMy WebLinkAboutBSN SPORTS INC - INSURANCE CERTIFICATE (2)ACORDe CERTIFICATE OF LIABILITY INSURANCE `�. UAT 212015D YYYY) B1ro2rm1s 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: N the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. N 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 endoreemen s . PRODUCER MARSH USA INC. CHASE TOWER CONTACT NAME: PHONE FAX A/C No: E-MAIL ADDRESS: 111 MONUMENT CIRCLE, SUITE 4300 INDIANAPOLIS, IN 46204-2492 INSURERS AFFORDING COVERAGE NAIC k INSURER A: Colony Insurance Company 39993 101168-BSN-Prop.14 5 INSURED BSA Sports, LLC DBA Tomark Sports, Inc. INSURER B : Travelers Property Casualty Co. of America 25674 wsuaeac: WA WA INSURER D: WA WA 1901 Diplomat Drive Farmers Branch, TX 75234 INSURER E: WA WA INSURER F COVERAGES CERTIFICATE NUMBER: CHI-004810260-04 REVISION NUMBER:1 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 LTR OF INSURANCE ADDLISUBRTYPE INSR MD POLICY NUMBER MM ODIYYYY MMIDD)YYX Y LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR X CONTRACTUAL LIABILITY 103GL000055603 0713012014 0713012015 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 1,000,000 MED EXP (My one person) $ EXCLUDED PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMPIOP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BA3F91639014CAG 1211212014 12/1212015 COMBINED SINGLE LIMIT (Ea accident 1000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) It PROPERTY DAMAGE Per aa:dent $ COMP/COLL DED $ 500 UMBRELLA LIAB EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DIED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERffXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) Kr. describe under DCRIPTION OF OPERATIONS below N/A YJUB4F02061414 12/1212014 V11212015 WC STATUSOTH- E. L. EACH ACCIDENT It 1'�'� E.L. DISEASE -EA EMPLOYE It 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Much ACORD 101, Additional Remarks Schedule, If more space Is required) Re: 1346239 The City, its officers, agents and employees are induded as additional insured (except workers' compensation) where required by written contract. City of Fart Collins 215 N. Mason St., 2nd Floor 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. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Shirley Murray M_ ACORD 25 (2010/05) © 1988-2010 The ACORD name and logo are registered marks of ACORD All riahts reserved