HomeMy WebLinkAboutAMERICAN BICYCLE ASSOCIATION DBA USA BMX - INSURANCE CERTIFICATE (6)AMERIBICI
Client#: 1067930
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDlYYYY)
1 2/27/2017
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
USI Insurance Services LLC
2375 E. Camelback Rd, Suite 250
TACT
NAME: Clorinda Thompson
PHONE 602-234-4101FAX
(A/CNN.,
/C No Ext : A/C, No):
p DDIL phx.certificates@usi.com
Phoenix, AZ 85016
INSURER(S) AFFORDING COVERAGE NAIC #
602 279-5800
INSURER A: Philadelphia Indemnity Ins.
18058 _
INSURED
American Bicycle Association
dba: USA BMX
INSURER B :
INSURER C
P.O. Box 718
INSURER D :
Chandler, AZ85244
INSURER E - -
INSURER F :
-----------
COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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
ADDLSUBR
INSR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YY
POLICY EXP
MM/DD/YYY
LIMITS
A
_
X'i COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
PHPK161583
3/01/2017
03/01/2018
EACH
$1,000,000
�OCCURRENCE
PREMISES Ea ocwr ence
$100000
MED EXP (Any one person)
$ Excluded
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
XI POLICY ECOT- �I LOC
OTHER:
GENERAL AGGREGATE
$5,000,000
PRODUCTS - COMP/OP AGG
$1,000,000
$
A
AUTOMOBILE LIABILITY
Xi ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
X HIRED AUTOS X NON -OWNED
AUTOS
_
PHPK161583
3/01/2017
03/01/201
EOaccNdeDtSINGLELIMIT
1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PerOa cideRPERTntDAMAGE
_
$
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
PHUB573938
3/01/2017
0310112011
EACH OCCURRENCE
s4,000.000
AGGREGATE
s4,000,000
DED I X RETENTION $10 000
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
PER OTH-
ISTATUTE
E.L. EACH ACCIDENT
$ -- - - - -
$
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate holder and any other entities listed below are listed as additional insured under the General
Liability on a primary & Non Contributory Basis including waiver of subrogation with respect to the
American Bicycle Association/USA BMX sanctioned events/competitions/practices and other operations
conducted by American Bicycle Association/USA BMX track operators on behalf of the American Bicycle
Association/USA BMX.
Re: Epic BMX
I.AINtiCLLM I IUIV
City of Ft. Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
P.O. Box 580 ACCORDANCE WITH THE POLICY PROVISIONS.
Ft. Collins, CO 80522-0580
AUTHORIZED REPRESENTATIVE
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
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