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ACOR l� DATE (MWDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE I07/31 /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 INSURERS), 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 endorsements).
PRODUCER CONTACT
NAME'
Willis of Texas, Inc.
c/o 26 Century BlvdPHONE 1-877-945-7378 wC N 1-888-467-2376
E-MAIL
P.O. Box 305191 ADDRESS: certifieatasQw111is. com
Nashville, TN 372305191 USA lumleemel seenamw rnuenar-e u�lrr
INSURER A: James River Inanrance Company 1 12203
INSURED INSURERS: Travelers Property Casualty Company of Awe 25674
BSN Sports, I=
14460 Varsity Brands Nay INSURER C:
Farmars Branch, TX 75244 USA INSURERD:
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: W12213724 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.
LTR TYPE OF INSURANCE INSD III - - ICY NU► BER
'—pOy�pary F
MMODWYMPOLICY - LIMITS --
X COMMERCIAL GENERAL LIABILITY
EACHOCCURRENCE
$ 11000,000
CLAIMS -MADE X OCCUR
PREMISES Ea ocarrence
$ 301000
A
MED EXP (Any oneperson)
$
y 00067824-5
07/30/2019
07/30/2020 PERSONAL ADV INJURY
i$ 11000,000
G_ ENI AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
$ 2,000,000
POLICY PRO- _ JECT LOC
PRODUCTS - COMPrOP AGG
Is 2,000,000
OTHER-.
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accidenll
j $ 11000.000
$
X ANY AUTO
BODILY INJURY (Per person)
B
OWNED SCHEDULED y TJ-CAP-6E004847-TIL-19
- AUTOS ONLY AUTOS
H
07/30/2019
07/30/2020 � BODILY INJURY (Per amidem)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Li acc_tlen�______..
$
$
A
UMBRELLA LIAR X OCCUR
EACH OCCURRENCE
$ 10,000,000
$ 10,000,000
X EXCESS LIAB CLAIMS_ -MADE
00063341-5
07/30/2019
07/30/2020AGGREGATE
$
DED RETENTION$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY y , N
B ANYPROPRIETOR'PARTNERIEXECUTIVE
OFFICERiMEMBER EXCLUDED? ❑ fillTC2J-US-6N324265-19
(Mandatory In NH)
07/30/2019
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $ 1, 000, 00
07/30/2020'
E.L. DISEASE - EA EMPLOYEE $ 1, 000, 000
If 9es. describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY LIMIT
$ 1, 000, 000
DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: 13-46239
The City, its officers, agents and employees are included as an
Additional Insured as respects to General
Liability
and Auto Liability.
4.M IYliCLLM I IVnI
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins AUTHORIZED REPRESENTATIVE
215 N. Mason St., 2nd Floor
PO Box 580 .tY%1Ci L,k_ (,�)�t_,�
Fort Collins, CO 80522 1'"'�S -
m 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
sA ID: 18324188 MTCa: 1307516
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