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HomeMy WebLinkAboutROLEXIS INC DBA TEAM SPORT PHOTO - INSURANCE CERTIFICATE (3),acoR" 011/1/2018 CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) 16.�, 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions off tthhe policy, certain policies may require an endorsement- A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Sentry Customer Service PHONE FAX A/C o t• 800-473-6879 A/C Nok 800-514-7191 Michele Regis EMAIL ADDRESS: busines roducts direct(osen .com INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: Sentry Insurance a Mutual Company 24988 INSURED INSURER B : INSURER C : Rolexis Inc Team Sport Photo INSURER D : 11860 Upham St Unit A INSURER E : Broomfield, CO 60020-2786 INSURER F : COVERAGES CERTIFICATE NUMBER: 940855 REVISION NUMBER: 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYY POLICY EXP MM/DD/YYY LIMITS X BUSINESSOWNERS LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES Ea Occurrence) $ 300,000 CLAIMS -MADE M OCCUR MED EXP (Any one person) $ 10,000 A X 4999863001 01/01/2019 01/01/2020 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY PRO JECT LOC � X PRODUCTS - COMP/OP AGG $ 3,000,000 $ OTHER: I I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 BODILY INJURY (Per person) $ F_ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS X 4999863001 01/01/2019 01/01/2020 BODILY INJURY (Per accident) $ PROPERTYDAMAGE $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE N / A STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Refer to attached CFRTIFICATE HOLDER CANCELLATION City of Foil Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 N Mason St 2nd R THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 4999863 Sentry Insurance a Mutual Company 3 00003 0000000420 18323 0 N Page 1 of 2 (9 19t3t;-ZU1* AGUKU GUKI'Uh1AI IUIV. All rignTS reserves. The ACORD name and logo are registered marks of ACORD 11 /17/2018 7D22A4C1-9859-4840-9CB3-E68247D8FEOD 0027020044347571353560522058080 AGENCY CUSTOMER ID: )000�'`IX8793 ACQRL�►® LOC #: — ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Michele Regis NAMEDINSURED Rolexis Inc Team Sport Photo POLICY NUMBER 4999863001 CARRIER Sentry Insurance a Mutual Company NAIC CODE 24988 EFFECTIVE DATE: 01/01/2019 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Businessowners Job: Going Onsite To Take Photos ACORD 101 (2008/01) Insurance © 2008 ACORD CORPORATION. All rights reserved. 4999863 Sentry Insurance a Mutual Company The ACORD name and logo are registered marks of ACORD 11/17/2018