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HomeMy WebLinkAboutAMERICAN BICYCLE ASSOCIATION DBA USA BMX - INSURANCE CERTIFICATE (7)AMERIBICI Client#: 1067930 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 CONTACT Clorinda Thompson _ FAX (A N o Ex1 , 602-234-4101 aC, No): 2375 E. Camelback Rd, Suite 250 E-MAIL phx-certificates@usi.com INSURER(S) AFFORDING COVERAGE NAIC # Phoenix, AZ 85016 602 279-5800 INSURER A: Philadelphia Indemnity Ins. 18058 INSURED American Bicycle Association dba: USA BMX P.O. Box 718 Chandler, AZ 85244 INSURER B INSURER C : INSURER D 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 ' POLICY EXP MM/DD/YYY MM/DD/YY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR _ PH PK161583 3/01 /2017 03/01/2018 EACH OCCURRENCE $1 OOO OOO $100000 RAMAGE TO RENTED PREMISES Ea occurrence MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO-JECT LOC OTHER: GENERAL AGGREGATE $5,000,000 PRODUCTS - COMP/OPAGG $1,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS PHPK161583 3/01 /20171, 03/01 /201 E° aocid.D SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY TY DAMAGE $ A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE PHUB573938 3/01/2017 03/01/2018 EACH OCCURRENCE s4,000,000 AGGREGATE s4,000,000 $ DED XFR ETENTION$10000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- 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 CERTIFICA The City of Fort Collins Purchasing Department PO BOX 580 Fort Collins, CO 80522-0000 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 (2014/01) 1 of 1 #S19952976/M19946903 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YVKZP