HomeMy WebLinkAbout159994 ODELL BREWING - INSURANCE CERTIFICATE (4)AC(J/2O®
C" CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDNYYY)
05/23/2019
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 rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT Dana Stewart, CIC, CISR
NAME:
Flood and Peterson
PHONE (970) 266-7149 FAX (970) 506-6845
A/C No Ext : AIC No):
E-MAIL DStewart@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Charter Oak Fire Insurance Company
25615
Greeley CO 80632
INSURED
INSURER B : Travelers Property Casualty Company of America
25674
INSURER C : Pinnacol Assurance
41190
Odell Brewing Company
INSURER D :
800 E. Lincoln Avenue
INSURER E :
INSURER F :
Fort Collins CO 80524
COVERAGES CERTIFICATE NUMBER: GL/AU/XS/WC x6/2020 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
ADDLSUBR
INSD
WVD
POLICY NUMBER
POLICY EFF
MMlDDIYY
POLICY EXP
MMIDDIYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE ® OCCUR
DAMAGE TO RENTE7_
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
A
630-21-1193508-COF-19
06/01/2019
06/01/2020
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY ❑ JECTPRO ❑ LOC
PRODUCTS - COMP IOP AGG
$ 2, 000,000
$
OTHER.
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
810-ON773698-19-14-G
06/01/2019
06/01/2020
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
H
s
-
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 10,000,000
B
EXCESS LIAB
CLAIMS -MADE
CUP-21-1193508-19-14
06/01/2019
06/01/2020
AGGREGATE
$ 10,000,000
DED I I RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE �
OFFICERIMEMBCERlMEMBER EXCLUDED?
(Mandatory In NH)
NIA
4210328
06/01/2019
06/01/2020
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
1,000,000
$
If yes, desuibe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Valentines Brunch Fundraiser
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
The City of Fort Collins Risk Management ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE c�--_�
Fort Collins CO 80522 ' ��p{�,(,!
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