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HomeMy WebLinkAbout282740 SPORT & FITNESS INC - INSURANCE CERTIFICATE (4)12/23/2015 4:36 PM FROM: Fax John C Beckett and Associates TO: 2246134 PAGE: 001 OF 001 ACORr qp CERTIFICATE OF LIABILITY INSURANCE `...�"1 DAM WD°YY"" 12/23/2015 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 endorsements . PRODUCER CONTACT NAME: JOHN C. BECKETT & ASSOCIATES INC. r PHONE PHONE (970) 484-2805 (970) 484-2885 No, Ext): (AAX No): 220 Smith Street IL ADDRESS: linda@beckettinsurance.com PRODUCER CUSTOMER D N.P S ort & Fitness, Inc. INSURER(S) AFFORDING COVERAGE NAICf Ft. Collins CO 80524— INSURED J INSURER A -M-qA UNDERWRITERS SPECIALTY Sport & Fitness, Inc. INSURER 8 :ESSEX INSURANCE CO 1409 Pikes Peak Avenue INSURER C INSURER D INSURER E Fort Collins CO 80524- 1INSURER F COVERAGES CFRTIFICATF NUMRFR- RFVISION NIIMRFR- 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. L ITR TYPE OF INSURANCE NSR WVD POLICY NUNEIER (MWDONYYY) (PW&DD/YYYY)P LIMITS A GENERAL LIABILITY Y 3DV9328 2/28/2015 2/28/2016 EACH OCCURRENCE $ 2,000,000 LMMERCIALGENERAL LIP,BILITY CLAIMS -MADE �OCCUR J J J J PREMISES Ea occuDAMAGE TO rence $ 100000 MED EXP (Any one person) $ 5000 anket addl insured PERSONAL & ADV INJURY $ 2,000,000 / / / J anket Primary& Waiver GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. / / / J PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC / / / / $ AUTOMDBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS 50 COVERAGE / / / / / / / / / / / J COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ NON -OWNED AUTOS $ $ UMBRELLA UAB HCLAIMS-MADE OCCUR 0 COVERAGE / / / J EACH OCCURRENCE $ EXCESS LIA9 / / / J AGGREGATE $ / / / / DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION YOU WILL HEED TO CALL / / / / VVC STATU- OTH- TORY LIMITS ER AND ENPLOYERS' LIABILITY YIN ANY PROPPIETORPARTNER/EXECUTIVE OFFICER,MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA PIHHACOL DIRECTLY FOR CERT. 800-873-7242 J J / / / / / J E.L. EACH ACCIDENT $ E.L.DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below # 4110269 / J / / EL DISEASE - POLICY LIMIT $ B BUSINESS PROPERTY 1CU1747 9/09/2015 9/09/2016 SPECIAL FORM 200,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attuh ACORD 101, Additional Rsmaras Sch"Ue, 9 mom spats is mwred) CITY OF FORT COLLINS ITS OFFICERS, AGENTS AND EMPLOYEES ARE LISTED AS ADDITIONAL INSURED ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION ( ) - (970) 224-6134 PURCHASING DEPT CITY OF FORT COLLINS 215 N N ASON 2ND FLOOR FORT COLLINS CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I+ •Ww ;µ y: f ACORD 25 (2009/09) @ 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD Allstate. You're In good hands. CERTIFICATE OF INSURANCE Cl C W A02 10 11 This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder. Named Insured: " -2 CITY OF FORT COLLINS SPORT AND FITNESS, INC J PO BOX 580 1409 PIKES PEAK AVE FORT COLLINS, CO USA 805220S80 FORT COLLINS CO 80524-4313 Automobile Liability Insurer Name: Allstate Insurance Company Poli Number: 648128822 1 Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass. Autos Only 4 Owned Autos Other Than Priv. Pass. Autos Only 5 - Owned Autos Subject to No Fault 6 - Owned Autos Subject to a Compulsory UM Law X 7 -- Specifically Described Autos X 8 - Hired Autos Only X 9 - Nonowned Autos Only Policy Effective Date : 12 -17 - 2 015 1 Policy Expiration Date: 12 -17 - 2 016 Limits of $1, 000, 000 1 Combined Single Limit (each accident) Insurance: BI Per Person I BI Per Accident PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Party Type: Additional Insured - municipality THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer: OLD TOWN INS INC Authorized Representative: Date:10-21-15 Includes copyrighted material of Insurance Services Office, Inc., with its permission CI CW A02 1011 Allstate Insurance Company Additional Insured Copy Page 1 of 1 Allstate. You're in good hands. POLICY NUMBER: 648128822 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds' for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: SPORT AND FITNESS, INC Endorsement Effective Date: 12 -17 - 2 015 SCHEDULE Name Of Person(s) Or Organization(s): CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO USA 805220580 I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. so BU„ 4B-3 CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Additional Insured Copy Page 1 of 1