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HomeMy WebLinkAboutROLEXIS INC DBA TEAM SPORT PHOTOS - INSURANCE CERTIFICATE (4)ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/25/2016 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 CONTACT NAME: Sentry Customer Service PHONE FAX A/C No Ezt : 800-473-6879 A/C No); 800-514-7191 Sentry Insurance Company 1800 North Point Drive EMAIL ADDRESS: businessproducts, directOsentr .com Stevens Point, WI 54481 INSURER(S) AFFORDING COVERAGE NAIC M INSURER A : SENTRY INSURANCE A MUTUAL COMPANY 24988 INSURED INSURER B: ROLEXIS INC DBA TEAM SPORT PHOTO INSURER C : INSURER D : 11880 UPHAM ST UNfr A 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 CERIIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POL !C!ES 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 SUER WVD POLICY NUMBER POLICY EFF MM/DD/YYY POLICY EXP MM/DD/YYY LIMITS X BUSINESSOWNERS LIABILITY EACH OCCURRENCE S 1,000,000 PREM SES AMAGE ToEa occurrDence $ 300,000 CLAIMS -MADE M OCCUR X MED EXP (Any one person) S 10,000 NON -OWNED AUTO q X 49-99863-01 01/01/2017 01/01/2018 X HIRED AUTO PERSONAL 3 ADV INJURY S 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000,000 POLICY ❑ PRO ❑ LOG JECT X PRODUCTS - COMP/OP AGG $ 3,000,000 $ OTHER: A AUTOMOBILE LIABILITYaccident) COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) S ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident] $ PROPERTY DAMAGE Per accident) $ HIRED AUTOS NON -OWNED AUTOS S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE S DED RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N STATUTE E FV E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE N / A OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below 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 BOX 560 ACCORDANCE WITH THE POLICY PROVISIONS. FORT COLLINS, CO 80522 AUTHORIZED REPRESENTATIVE I ACORD 25 (2014/01) 4999863 0010 Page 1 of 2 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10/25/2016 1 00001 0000000179 16300 0 N 81DA4163-5746-4E42-A5F5-FF2F73652938