HomeMy WebLinkAboutFORT COLLINS ARCHERY ASSOCIATION - INSURANCE CERTIFICATEA� v CERTIFICATE OF LIABILITY INSURANCE u Ictmmnnnr"'I
6/30/2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVKL 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 &EIRTIFICAto 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).
Leavitt Recreation 6 Hospitality Insurance,
942 14th Street
SD
`...'L kell- -jones@leavitt.com y'] _
Fort Collins Archery Association INSURER 0:.
P.O. Box 270493 INSURER E:
Fort Collins CO 80525 INSURER F:
- 'wCTermrna� unaancn.on_01 nnr RPVICInN IJIIMRFR-
t8661466-2797
THISIS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEDBELOW
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE
HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
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.
WSR
TYPE OF INSURANCE.
ADOL
Sl1BR
IPOLICY NUMBER
M/DDNYYY
M/DDNYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
S 1,000,000
A
CLAIMS -MADE ❑ OCCUR
DAMAGE TO N
PREMISES a oocurnencalS
100,000
MED EXP(Any oneperson)
_
S 5,000_
X
PRPA2152773
7/1/2020
7/1/2021
PERSONAL sADV. INJURY
S 1, 000,000
GENIAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 2-1000,000
PRODUCTS-.COMP/OPAGG
S 2,000,000
%t PRC- ❑
POLICY JECT LOC
S
OTHER:
AUTOMOBILE LIABILITY
COMBINED
e aaxm ideSINGLE LIMIT
$
BODILY INJURY (Per person)
3
ANY AUTO
BODILY INJURY (Par accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
NON.—ED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
e accident)
3
S
UMBRELLA UAB
OCCUR
EACH OCCURRENCE
S.
AGGREGATE
3
EXCESS LIAa
CLAIMS-MAOE
I
DIED RETENTION-$
$
WORKERS COMPENSATION
_ _ _
- -
PER OT -
STATUT ER
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
EL. EACH. ACCIDENT
S. _
E.L..DISEASE- EA EMPLOYEE
3
OFFICER/MEMSER EXCLUDED? ❑
(Mandatory In NH)
NIA
E.L. DISEASE- POLICY LIMIT
S
If yes, describe under
DESCRIPTION OF OPERATIONS bel"
OESC;RIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACARD 101, Atltlkional
IT IS UNDERSTOOD AND AGREED THAT THE CERTIFICATE
Remarks Schedule, may be albchatl N mom apace Is required)
HOLDER IS NAi3ED AS ADDITIONAL INSURED, BUT ONLY WITH
RESPECT TO ITS LIABILITY ARISING OUT OF THE
ACTIVITIES OF THE NAI-M INSURED.
City of Fort Collins
P.O. Box 580
Fort Collins, CO 80521-0580
SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
'hris Hipple/MISHAE K
ACORD 25 (2014/01) The ACORD name and logo are registered marks ofACORD
INS025 (201401),