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Home My WebLink About118458 FORT COLLINS ARCHERY ASSOCIATION - INSURANCE CERTIFICATE (2)A� " CERTIFICATE OF LIABILITY INSURANCE DATE (M MIDD/YYYY) 6/28/2019 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 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 NAME: Kelly Jones PHONE (800)525-2060 I FAX A/C,No: (866)465-2797 Leavitt Recreation & Hospitality Insurance, Inc. E-MAIL ADDRESS: kelly-jones@leavitt.com 942 14th Street INSURERS AFFORDING COVERAGE NAIC # INSURERA:Philadelphia Indemnity Insurance Com ar 18058 Sturgis SD 57785 INSURED INSURER B : INSURER C: Fort Collins Archery Associati INSURER D: P.O. Box 270493 NSURER E: Troy Tafoya INSURER F: Fort Collins CO 80525 Lr1VFRAr7FR r:FRTIFICATF NIIMRFR•19-2U YUi KtV151UN NUMtSt K: 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 SUBR POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑OCCUR DAMAGE TO PREMISES (Ea ocurrrrence) $ 100,000 MED EXP (Any one person) $ 5,000 X PHPK2005807 7/1/2019 7/1/2020 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2, 000, 000 PRODUCTS-COMP/OPAGG S 2,000,000 X POLICY ❑ JEPRO- ❑ LOC S OTHER: I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE Per accident S UMBRELLALIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N/A PER OTFI - STATUTE ER E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) IT IS UNDERSTOOD AND AGREED THAT THE CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED, BUT ONLY WITH RESPECT TO ITS LIABILITY ARISING OUT OF THE ACTIVITIES OF THE NAMED INSURED CFRTIFICATF 1-I0l nFR GANL;tLLAIIUN City of Fort Collins P.O. Box 580 Fort Collins, CO 80521-0580 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 s Hipple/ANSTAR no 19RR-2n14 ACORD CORPORATION. All riahts reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)