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HomeMy WebLinkAboutAMERICAN BICYCLE ASSOCIATION DBA USA BMX - INSURANCE CERTIFICATE (3)Client#: 1067930 AMERIBIC1 ACORD. 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 CONTACT USI Insurance Services LLC PHONE C602-2a Thompson AX AJC No Ext : 602-234-4101 A/C, No): 2375 E. Camelback Rd, Suite 250 E-MAIL ess: phx.cortificates@usi.com AZ 85016 INSURER(S) AFFORDING COVERAGE NAIC N INSURER A : Philadelphia Indemnity Insurance Co. 18058 INSURED American Bicycle Association dba: USA BMX P.O. Box 718 Chandler, AZ 85244 INSURER B : INSURER D : INSURER E : INSURER F : COVERAGES CFRTIFICATF NIIMRFR• nwlclnu uua.o�e. 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUB WVD POLICY NUMBER POLICY EFF POLICY EXP MM/DD/YYYY MM/DD LIMITS A X1 COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR X X PHPK1948481 3/01/201903/0112020 EACH OCCURRENCE $1 000,000 PREMISETOREoNcTEDnce $100,000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: RO- POLICY JECT F7 LOC GENERAL AGGREGATE $ 5,000,000 GEN'L X PRODUCTS - COMP/OP AGG $1,000,000 $ OTHER: A AUTOMOBILE LIABILITY PHPK1948481 3/01/2019 03/01/202 COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB X OCCUR PHUB666364 3/01/2019, 03/0112020 EACH OCCURRENCE $4 O00 OOO EXCESS LIAR CLAIMS -MADE AGGREGATE s4.000.000 DED I X RETENTION $1 O 000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � N / A PER OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) 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 #1352 -MI lvll. IC 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 (2016103) 1 of 1 #S25133873/M25120770 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JYCZP