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Home My WebLink About143207 NEW BELGIUM BREWING COMPANY INC - INSURANCE CERTIFICATE (4)ACORD, CERTIFICATE OF LIABILITY INSURANCE 12/1/2016 [__DATE(MMlDDlYYYY) I 1 /23/2015 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 endorsement(s). PRODUCER Lockton Companies CONT CT NAME: 8110 E Union Avenue Suite 700 Denver CO 80237 PHONE, FAX A/C, No Ext : A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A : The Hanover American Insurance Company 36064 INSURED New Belgium Brewing Company, Inc. INSURER B : The Hanover Insurance Company 22292 1350260 500 Linden Street Fort Collins CO 80524 INSURER C : Allmerica Financial Benefit Insurance Co 41840 INSURER D : INSURER E : I INSURER F : I I COVERAGES NEWBE01 CERTIFICATE NUMBER: 13354403 REVISION NUMBER: XXXXXXX 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDlYYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY Y N ZZ48945648-05 12/1/2015 12/1/2016 EACH OCCURRENCE 1.000000 CLAIMS -MADE � OCCUR PREM SESGE � a oNcurrDence 1,000,000 MED EXP (Any oneperson) 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER. POLICY PE LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER $ B AUTOMOBILE LIABILITY N N AH4 8902695-05 12/1/2015 12/1/2016 (COaBINEDtSINGLE LIMIT $ 1,000 OOO X BODILY INJURY (Per person) $ �{}��{�{XXX ANY AUTO AUTOWNED SCHEDULED AUTOS X BODILY INJURY (Per accident $ XXXXXXX X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ XXXXXXX Comp/Coll Ded. $ See Below B X UMBRELLA LIAR }{ OCCUR N N Ulf48903631-05 12/1/2015 12/1/2016 EACH OCCURRENCE $ 20,000,000 AGGREGATE $ 20.000 000 EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ }{j{}{}{XXX C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DF. SCRIPTION OF OPERATIONS below N / A N WM4A45199402 (AOS) W24A48960601 (CA, DE &. MI) 12/1/2015 12/1/2015 12/1/2016 12/1/2016 PER OTH- X STATUTE E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DICEASE - POLICY LIMIT /� /� 1.000.000 A Liquor Liability N N ZZ48945648-05 12/1/2015 12/1/2016 $ 1,000,000: Each Common Cause $2,000,000: Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Comp/Coll Deductible: $500/$2,000 Heavy Truck. RE — Event: 'Four de Fat Fort Collins, Date and Times: Thursday, September 3, 2015 from 5pm to IOpm — Friday, September 4, 2015 from 7am to 10pm — Saturday, September 5, 2015 from 6am to 11:59pm — Sunday, September 6, 2015 from lam to 12pm. The City of Fo Collins, its officers, agents, employees and volunteers are included as Additional Insured as respects General Liability if required by written contract. CERTIFICATE HOLDER CANCELLATION See Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 13354403 AUTHORIZED REPRESENTATIVE City of Fort Collins Attn: Risk Management PO Box 580 Fort Collins, CO 80522-0580 ACORD 25 (2014101) ©1 8 2014 ACORD CORPO ATION. All rights reserved Thn ACr1Rr1 nnmc onrl Innn oru runictamel m Lrc of A(,r)pn ACORD, CERTIFICATE OF LIABILITY INSURANCE 12/1/2016 DATE(MM/DD/YYYY) 1 I /23/2015 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 endorsement(s). PRODUCER Lockton Companies CONT CT NAME: NE, FAX A/C No Ext : A/C, No): 8110 E Union Avenue Suite 700 Denver CO 80237 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A : The Hanover American Insurance Company 36064 INSURED New Belgium Brewing Company, Inc. INSURER B: The Hanover Insurance Company 22292 1350260 500 Linden Street Fort Collins CO 80524 INSURER C : Allmerica Financial Benefit Insurance Co 41 840 INSURER D : INSURER E : INSURER F : COVERAGES NEWBE01 CERTIFICATE NUMBER: 12391 124 REVISION NUMBER: XXXXXXX 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx] OCCUR Y N ZZ48945648-05 12/1/2015 12/1/2016 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES Fa occurrence l ,000,000 MED EXP (Any oneperson) 10,000 PERSONAL & ADV INJURY $ 1,000,000 L AGGREGATE LIMIT APPLIES PER. POLICY JEC LOC POTHER GENERAL AGGREGATE $ 2,000 000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO AUTOWNED SCHEDULED NON -OWNED HIRED AUTOS X AUTOS N �( AH4 8902695-05 12/I/2015 12/1/2014 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ XXXXXXX X BODILY INJURY (Per accident $ XXXXXXX X PROPERTY DAMAGE Per accident $ XXXXXXX Comp/Coll Ded. $ See Below B X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE N N Ul148903631-05 12/1/2015 12/1/2016 EACH OCCURRENCE $ 20000,000 AGGREGATE $ 20,000 000 DED I I RETENTION $ $ XXXXXXX C L WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANV PROPRIETOR/PARTNERlEXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N WM4A45199402 ((AGS) W24A48960601 (CA, DE & MI) 12/1/2015 12/1/2015 12/1/2016 12/1/2016 PER OTH- X STATUTE E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1 ,000,000 E.L. DISEASE -POLICY LIMIT 1 1,000.000 A Liquor Liability N N ZZ48945648-05 12i 1i2015 12/ 1/2016 51,000,000: Each Common Cause $2,000,000: Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Comp/Coll Deductible: $500/$2,000 Heavy Truck. RE: Tour de Fat Fort Collins, August 28th, 2014 - August 30th, 2014. The City of Fort Collins, its officers, agents, employees and volunteers are listed as Additional Insureds with respect to General Liability if or when required try written contract, agreement, or permit. CERTIFICATE HOLDER CANCELLATION See Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12391124 AUTHORIZED REPRESENTATIVE City of Fort Collins Risk Managgement P.O. Box 580 Fort Collins CO 80522 C /J ar% � ILr ACORD 25 (2014/011 ©19 8 2014 ACORD CC ATION. All rights reserved Thn ArOPn nmmn nnel Inn^ zra ranictarari m—ke of arr)pn