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HomeMy WebLinkAboutROLEXIS INC DBA TEAM SPORT PHOTOS - INSURANCE CERTIFICATE (2)I IV ACOR" CERTIFICATE OF LIABILITY INSURANCE DATEmYY) 04/24/2019019 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 oft thhe 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 AME: Sen Customer Service PHONE FAX A/C : 800-473-6879 No); 800-514-7191 Michele Regis EMAIL ADDRESS: busines roducts directOsen .com INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: Sentry Insurance a Mutual Company 24968 INSURED INSURER B : Rolexis, Inc. 11880 Upham St Unit A INSURER C : INSURER D : Broomfield, CO 80020-2786 INSURER E : 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 SUER WVD POLICY NUMBER POLICY EFF MM/DD/YYY POLICY EXP /DD MMNYY)J LIMITS A X BUSINESSOWNERS LIABILITY CLAIMS -MADE X� OCCUR X 4999863001 01/01/2019 01/01/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (a occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO ❑ LOC JECT OTHER: GENERAL AGGREGATE $ 3,000,000 X PRODUCTS - COMP/OP AGG $ 3,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNFD SCHEDULED AUTOS ONLY AUTOS NON -OWNED X HIRED Ix AUTOS ONLY AUTOS ONLY X 4999863001 01/01/2019 01/01/2020 COMBINED SINGLE LIMIT (Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ PROPERTY DAMAGE Per acciden $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER DCCLUDED9 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A FT OTH- STALITE ER E.L. EACH ACCIDENT $ E.L.. DISEASE- EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Refer to attached CERTIFICATE HOLDER CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 N Mason St 2nd FI 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 0000000434 19114 0 N Page 1 of 2 O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 04/24/2019 A2526COF-COOF-4B7E-B569-3E93A19F3912 0027020044349827536180522058080 AGENCY CUSTOMER ID: x70=XP793 AC RO D® LOC #: _ ADDITIONAL REMARKS SCHEDUI E Page 2 of 2 AGENCY Michele Regis NAMEDINSURED Rolexis, Inc. 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 Liability Insurance Businessowners Job: Going Onsite To Take Photos ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. 4999863 The ACORD name and logo are registered marks of ACORD 04/24/2019 Sentry Insurance a Mutual Company