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HomeMy WebLinkAboutROLEXIS INC DBA TEAM SPORT PHOTO - INSURANCE CERTIFICATE (6)AC'ORCa' CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/20/2015 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 endorselnent(s). PRODUCER CONTACT NAME: Sentry Customer Service WILLIAM J ALBERT PHONE FAX A/C No Ext: 800-295-6919 A/C No: 600-514-7191 EMAIL ADDRESS: business roducts direct0senb .com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A; SENTRY INSURANCE A MUTUAL COMPANY 24988 INSURED INSURER B : ROLEXIS INC DBA TEAM SPORT PHOTO 11880 UPHAM STUNT INSURER C: INSURER D : BROOMFIELD, CO 80020 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 0010 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 !SSUED 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYY POLICY EXP MM/DD/YYY LIMITS X I BUSINESSOWNERS LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F�] OCCUR DAMAGE TO RENTED PREMISES Ea occu,p $ 300,000 X NON -OWNED AUTO MED EXP (Any one person) $ 10,000 q X 49-99803-01 01/01/2015 01/01/2018 X HIRED AUTO PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3.000,000 I ❑ JECTElPRO POLCY LOG X PRODUCTS - COMP/OP AGG $ 3,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB H CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE N / A OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE S (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 N MASON ST2ND FL THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX580 ACCORDANCE WITH THE POLICY PROVISIONS. FORT GOLLINS, CO $0524 AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) 4999863 0010 1 00001 0000000191 15294 0 N Page 1 of 2 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD E6583531-2D82-4BA0-A984-E857499CC90E 10/20/2015 AGENCY CUSTOMER ID: ACURC�® AGENCY WILLIAM J ALI3ERT POLICY NUMBER 49-99863-01 CARRIER ADDITIONAL REMARKS LOC #: — ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMEDINSURED ROLEXIS INC DBA TEAM SPORT PHOTO EFFECTIVE DATE: 01/01/2015 Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. 4999863 The ACORD name and logo are registered marks of ACORD 10/20/2015 SENTRY INSURANCE A MUTUAL COMPANY SENTRY'S BUSINESSOWNERS STEVENS POINT, WISCONSIN POLICY (A PARTICIPATING MUTUAL COMPANY) A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES POLICY NUMBER 49-99863-01 NAME INSURED: ROLEXIS INC DBA TEAM SPORT PHOTO ADDITIONAL INSURED SCHEDULE The following information is required to complete the accompanying additional insured endorsement which forms a part of the Named Insured's BUSINESSOWNERS POLICY. ADDITIONAL INSURED ENDORSEMENT CITY OF FORT COLLINS BP 04 50 07 13 215 N MASON ST 2ND FL PO BOX 580 FORT COLLINS, CO 80524 (CERTIFICATE NUMBER 0010) LOCATIONS) OF COVERED OPERATIONS CITY OF FORT COLLINS PO BOX 580 215 N MASON ST 2ND FL FORT COLLINS, CO 80522 JOB: GOING ONSITE TO TAKE PHOTOS FOR ENDORSEMENT TEXT, SEE OVER. BP 89 05 01 87 (MECH) TEA 49-99863-01 00 151 10-20-2015 (000 0010) EFFECTIVE FROM JANUARY O1, 2015 TO JANUARY O1, 2016 01FMORG 01204