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HomeMy WebLinkAboutROLEXIS INC DBA TEAM SPORT PHOTO - INSURANCE CERTIFICATE (7)]Ri7 CERTIFICATE OF LIABILITY INSURANCE ik. 10/00�2M/YYYY) OM/DD 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(1es) 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 endorselnent(s). PRODUCER William Albert CONTACT NAME: Sent Customer Service PHONE FAX A/C No Ext: 800-295-6919 A/C No; 800-514-7191 EMAIL ADDRESS: business roducts directAlsen .com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Sentry Insurance a Mutual Company 24988 INSURED INSURER B : Rolexis Inc Team Sport Photo INSURER C : INSURER D : 11880 Upham St Unit A Broomfield, CO 80020-2786 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 940855 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 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYY POLICY EXP MM/DD/YYY LIMITS q X BUSINESSOWNERS LIABILITY CLAIMS -MADE M OCCUR X 4999863001 01/01/2018 01/01/2019 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) S 10,000 PERSONAL & ADV INJURY S 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC JECT OTHER: GENERAL AGGREGATE $ 3,000,000 X PRODUCTS - COMP/OP AGG $ 3,000,000 S A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X 4999863001 01/01/2018 01/01/2019 COMBINED (Ea acident�SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY Peracciden ( t) $ X PROPERTY DAMAGE Per acciden' S UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE F i OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Refer to attached CERTIFICATE HOLDER CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 N Mason St 2nd R THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 4999863 Sentry Insurance a Mutual Company 3 00003 0000000403 17282 0 N Page 1 of 2 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10/06/2017 269FDBA3-E7D4-4525-8545-CE9C59526412 0027020044342350157280522058060 ACOR" AGENCY CUSTOMER ID: XXXXXX8793 LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 WENCY NAMED INSURED Nilliam Albert Rolexis Inc Team Spat Photo )OLICY NUMBER 1999863001 ;ARRIER NAIL CODE >enty Insurance a Mutual Company 249B8 EFFECTIVE DATE: 01/01/2018 tDDITIONAL REMARKS r ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, NUMBER: ACORD 25 FORM TITLE: Certificate of Liabilitv Insurance BUSiflessownerS Job: Going Onsite To Take Photos ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. 4999863 The ACORD name and logo are registered marks of ACORD 10/06/2017 Sentry Insurance a Mutual Company