HomeMy WebLinkAbout123508 BASE CAMP INC - INSURANCE CERTIFICATEBASECAM-01 JULIER
,ncoRo CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD YYYY)
�i 7123/2019
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)
NTACT
PRODUCER C N ME:
5660 Greenwood Plaza Blvd.
Suite 500
Greenwood Village, CO 80111
INSURED
B.A.S.E. Camp, Inc.
Attn: Seth Kelley
1224 E Elizabeth St
Fort Collins, CO 80524
799-0110 A/C, Nei:(303) 799-0158
INSURER(S) AFFORDING COVERAGE _.
A • Great American Ins Comoanv 1 E
unam co. RPVLCIrTN NIIMRFR-
VVYGRNV
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,
INBR ILTR TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POvivoLICY EXP LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
AbuselMolest IM/2M
X
PAC2143307
7/1512019
I
7/15/2020
EACH OCCURRENCE
$ 1'ODO'000
DAMAGE TO RENTED
100'000
X
MED XP (A�Ea�ue so^
5,000
X
Prof Liab 1 MI2M
PERSONAL 6 ADV INJURY
1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY jecT LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMPIOP AGG
2,000,000
A
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea ocident)
$ 1,000,000
BODILY INJURY Perperson)
ANY AUTO
PAC2143307
7/15/2019
7/15/2020
BODILY INJURY Par accident
$
OWNED SCHEDULED
AURTEO�S ONLY AUpTNO.pSWN�p
X AUTOS ONLY X N OS ONLY
502 AMAGE
$
A
X
UMBRELLA LIAB
EXCESS LAB
X
OCCUR
CLAIMS -MADE
UMB2143308.
7/15=19
7115/2020
EACH OCCURRENCE
$ 1'�'�g�
AGGREGATE
$ 1,000, 00
DED I X RETENTION $ 10,00�
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN
'j
FFFICER/MEMg�q EXCLUDED? �f
,Mandatory In NHj
NIA
STEARTUTE OTH-
ER
El- EACH ACCIDENT
$
EL DISEASE - EA EMPLOYE
E
E.L. DISEASE -POLICY LIMIT
Aggregate
1,000,000
If yes. describe under
DESCRIPTION OF OPERATIONS below
B Directors & Officers
IPHSD1428871
4/23/2019
4/23/2020
C Student Accident
134SR844922
7/1512019
7/15/2020
Medical Payments
25,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Re. BASE Camp Family Fun Fair, April 29, 2017
As required by written contract or written agreement, the City of Fort Collins is included as Additional Insured under General Liability.
City of Fort Collins
Financial Services/Risk Management
215 N. Mason St. 2nd FI.
PO Box 580
Fort Coilins, CO 80522
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) C 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD