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Home My WebLink AboutBOOT BARN HOLDINGS INC - INSURANCE CERTIFICATEA� o® CERTIFICATE OF LIABILITY INSURANCE TE DAO/3/2019 n /2 9 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 arid 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 endorsemeint(s). PRODUCER Woodruff -Sawyer & Co. 2 Park Plaza, Suite 500 Irvine CA 92614 CONTACT Kristen MoodyFAX HONE , 949.435.7348 ac No): 949.47613118 ADss:_kmood wsandoo.com INSURERS AFFORDING COVERAGE NAIC B INSURERA: National Surety Corporation 21881 INSURED BOOTBAR-01 Boot Barn Holdings, Inc. 15345 Barranca Parkway INSURER B : Travelers Prop Casualty Co of America 25674 INSURER C : Fireman's Fund Insurance Company 21873 INSURERD: American Automobile Insurance CornLaty 21849 Irvine CA 92618 INSURER E.:. _ INSURER F., COVERAGES CERTIFICATE Nt1MBERc 15dnRRRR07 DPVISIrllJ NIIMRFD- 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'SUBR POLICYNUMBER POLICY EFF MMIDD .POLICY EXP MMIDD _ LIMITS, C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR Y USCO07559190 10/1/2019 10/1/2020 EACH OCCURRENCE $1,000,000 DAMAG PREMISES a occurrence $100,000 MED EXP Any one person $ 5,000 PERSONAL & ADV INJURY $1,060,000 AGGREGATE LIMIT APPLIES PER: POLICY PRO. LOC GENERAL AGGREGATE $2,000,000 GEN'L X PRODUCTS -COMPIOPAGG $2,D00,000 $ OTHER: D AUTOMOBILE LIABILITY Y SCV0009481901 10/1/2019 10/1/2020 - - COMBINEDSINGLE LIMIT Ea accident $1,000,000 X BODILY INJURY (Per Person) $ ANY AUTO AUTOES ONLY AUTOEDSULED BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident Comp &.Collision Ded $1,000 B X UMBRELLA UAB X OCCUR ZUP41NO154719NF 10/1/2019 10/1/2020 EACH OCCURRENCE $25,000.000 AGGREGATE $ 25,000,000 EXCESS LIAB CLAIMS -MADE DED I X. I RETENTION S. $ A ANDREMPLO ERS'LI BILITY Y/N ANYPROPRIETORIPARTNER/EXECU-nVE OFFICER/MEMBEREXCLUDEDT El N/A. SCW01161019 10l1J2019 10/1/2020 X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000.000 (Mandatory in NH) describe under under If DESCRIPTION DES , describe below E.L. DISEASE - POLICY LIMIT $ 1,000.000 DESCRIPTION OF OPERATIONS / LOCATONS / vEN1OLEs (ACORD 101, Additional Remarks Schedule, may be attached it more apace is required) Named Insureds: Boot Barn, Inc.; Boot Barn Holdings, Inc.; RCC Western Stores, Inc:; Baskins Acquisition Holdings LLC; Baskins Western & Work Wear; Sheplers Holding Corporation; Sheplers, Inc. City of Fort Collins is included as an Additional Insured as respects General Liability and Auto Liability per attached form. City of Fort Collins Finance & Purchasing Department 215 N. Mason St, 2nd Floor Fort Collins 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. riahts ACORD 25 (2016/63) The ACORD name and logo are registered marks of ACORD