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HomeMy WebLinkAboutAMERICAN BICYCLE ASSOCIATION DBA USA BMX - INSURANCE CERTIFICATE (2)Client#: 1067930 AMERIBIC1 ACORDT, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/05/2019 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 of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER C NAME; NTACT Clorinda Thompson USI Insurance Services LLC PHONE 602-234-4101 FAX AIC No Ext : A/C No 2375 E. Camelback Rd, Suite 250 a DRIESS: phx.certificates@usi.com Phoenix, AZ 85016 - INSURED American Bicycle Association dba: USA BMX P.O. Box 718 Chandler, AZ 85244 COVFRAGFS CFRTICI!`ATC h1111u192CO. INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: PhMdelphie Indemnity Ineumnee Co. 18058 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : 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 CONTRACTOR 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. —SR AN LTR TYPE OF INSURANCE ADD L INSR SUB WVD POLICY NUMBER MM/DDY EFF MMI IDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE n OCCUR X X PHPK1948481 3/01/2019 03/01/202 EAACCH�OECCCURRENCE $1,000,000 PREMISES Ea oNccTurrence $1 OO OOO MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY ECT F� LOC GENERAL AGGREGATE $ 5,000,000 PRODUCTS - COMP/OP AGG $1,000,000 OTHER: A AUTOMOBILE LIABILITY ANY AUTO SCHEDULED AUTOS X AUTOS ONLY PHPK1948481 3/01/2019 03/01/202 EeaccidenSINGLELIMIT 1,000,000 X XNON-OWNED BODILY INJURY (Per person) $ BODILY INJURY (Per accident) - — $ PROPERTY DAMAGE Per accdent $ 4LIAB A XIAB X OCCUR PHUB666364 3/0112019: 03/01/202 EACH OCCURRENCE s4,000,000 CLAIMS -MADE AGGREGATE $4 000 000 ETENTION $1 O 000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N / A PER OTH- STATUTE JER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ Mandatory in If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder and any other entities listed below are listed as additional insured under the General Liability on a primary & Non Contributory Basis including waiver of subrogation with respect to the American Bicycle Association/USA BMX sanctioned events/competitions/practices and other operations conducted by American Bicycle Association/USA BMX track operators on behalf of the American Bicycle Association/USA BMX. RE: Twin Silo BMX The City of Fort Collins C/O John Stephen 215 N. Mason Fort Collins, CO 80524-0000 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 ACORD 25 (2016/03) 1 of 1 #S25134392/M25120770 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JYCZP