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HomeMy WebLinkAbout282740 SPORT & FITNESS INC - INSURANCE CERTIFICATE (5)Allstate. You're in good hands. CERTIFICATE OF INSURANCE Cl CW A02 10 11 This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder. Named Insured: CITY OF FORT COLLINS SPORT AND FITNESS, INC PO BOX 580 1409 PIKES PEAK AVE FORT COLLINS, CO USA 805220580 FORT COLLINS CO 80524-4313 Automobile Liability Insurer Name: Allstate Insurance Company PolicyNumber 648128822 1 Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass. Autos Only 4 Owned Autos Other Than Priv. Pass. Autos Only 5 - Owned Autos Subject to No Fault 6 - Owned Autos Subject to a Compulsory UM Law X 7 -- Specifically Described Autos X 8 - Hired Autos Only X 9 - Nonowned Autos Only Policy Effective Date : 12 -17 - 2 017 Policy Expiration Date: 12 -17 - 2 018 Limits of - $1, 000, 000 1 Combined Single Limit (each accident) Insurance: BI Per Person I BI Per Accident PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Party Type: Additional Insured - Municipality THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer: OLD TOWN INS INC Authorized Representative: Date:10-23-17 Includes copyrighted material of Insurance Services Office, Inc., with its permission BU114R-3 Cl CW A02 10 11 Allstate Insurance Company Additional Insured Copy Page 1 of 1 Q, Allstate. You're in good hands. POLICY NUMBER: 648128822 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: SPORT AND FITNESS, INC Endorsement Effective Date: 12 -17 - 2 017 SCHEDULE Name Of Person(s) Or Organization(s): CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO USA 805220580 I Information required to complete this Schedule if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section 11 — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. BU114R-3 CA20481013 © Insurance Services Office, Inc., 2011 Additional Insured Copy Page 1 of 1