HomeMy WebLinkAbout524235 MONARCH MEDIA INC - INSURANCE CERTIFICATE (3)A R
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
1/8/2018
THIS CERTIFICATEIS 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 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
PAYCHEX INSURANCE AGENCY INC/PAC
250881 P: F:(888) 443-6112
PO BOX 33015
SAN ANTONIO TX 78265
CONTACT
NAME:
�A/NCNo.E,t):
(A/O,No): (888) 443-6112
Ems" ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC4
INSURERA: MUltlple Companies
INSURED
MONARCH MEDIA, INC.
406 MISSION ST STE J
SANTA CRUZ CA 95060
INSURER B
INSURER C
INSURER D:
INSURER E:
INSURER F
CnVFRArOFS CFRTIFICATF NHIMIRFR- KEVISION NUMBEK:
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.
LN.SR
TYPE OF LVSURdNI'E
ADD
Srx
POLLGTN►JMB6'Lt
POLICYL14
M*A4TYY
POLKTEXP
IIMI
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
$
PERSONAL &ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
$
POLICY PRO LOG
JECT
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)HIRED
PROPERTY DAMAGE
(Per accident)
$
NON -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
$
DE
RETENTION 5
WORXF1t110MPENS.J1!O1
dNDFMPLDYFYrLLJBR.r(Y
X PER OTH-
STATUTE ER
ANY PROPRIETORlPARTNER/EXECUTIVEY/N
E-L. EACH ACCIDENT
_
$110 0 0, 0 0 0
A
OFFICERIMEMBEREXCLUDED?
(Mandatory in NH) ❑
wA
76 WEG PH3984
01/30/2018
01/30/2019
E.L.. DISEASE -EA EMPLOYEE
$ 1 , 000, 000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
1,000, 000
11,000,
i
[:::p
DESCRIPTION OF OPERATIONS JLOCATIONS / VEH►CPEDRD 101, Additional Remarks Schedule, may be attached if more space is required)
Those usual to the Insured's Operations. Certificate Holder is an Additional
Insured per the Business Liability Coverage Form SS0008 attached to this
policy.
IC r1VLUCK
City of Fort Collins, Colorado
Attn: David Carey
PO BOX 580
FORT COLLINS. CO 80522
�.JYr�V GLLM r ryr�
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
ACORD 25 (2016103)
r@11 GY.f:�&llii t.1
The ACORD name and logo are registered marks of ACORD
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