HomeMy WebLinkAbout524235 MONARCH MEDIA INC - INSURANCE CERTIFICATE (4)CERTIFICATE OF LIABILITY INSURANCE
[DATE (MXDDIYYYY)
2/31/2016
THIS CERTIFICATEIS 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 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 endorsement(s).
PRODUCER
PAYCHEX INSURANCE AGENCY INC/PAC
250881 P: F: (888) 443-6112
PO BOX 33015
SAN ANTONIO TX 78265
CONTACT
NAME
(a° o,Exq:
wcN-): (888) 443-6112
EAWL
ADDRESS
INSURERS) AFFORDING COVERAGE NAIC*
INSURER A: Multiple Companies
INSURED
MONARCH MEDIA, INC. T
406 MISSION ST STE U
SANTA CRUZ CA 95060
INSURER B
INSURER C
INSURER O .
INSURERE
INSURER F:
rnVFRArFs CFRTIFICATE 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 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.
luvlq?
71PEOFINSUR4NCE
ADDL
SUBB
POLICTNUMBER
POL11-1
D YTFY
TOLIGTF_iT
LAITIS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
CLAIMS -MADE ❑
PREMISESS(OCCUR DAMAGERENTED
(Ea occurrence)
—_
MED EXP (Any one person)
PERSONAL & ADV INJURY
GEN'LAGGREGATE
LIMIT APPLIES PER:
GENERALAGGREGATE
g
PRODUCTS-COMPIOP AGG
g
POLICY PRO- LOC
JECT
OTHER:
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
(Ea accident)
_
BODILY INJURY (Per person)
n
ANY AUTO
f OWNED SCHEDULED
BODILY INJURY (Per accident)
i
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
(Per accident)
g
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
EXCESS LIAR
CLAIMS -MADE
AGGREGATE
-
DE
RETENTION S
i
wORKEASCOMPEN.SADON
ANDEMPLDI'ERS'7IABWn
ANY PROPRIETORIPARTNER/EXECUTIVEY/N
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
11,000,000
A
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH) ❑
NIA
76 KEG PH3984
01/30/2017
01/30/2018
E.L. DISEASE -EA EMPLOYEE
"] y 000 y 000
E.L. DISEASE - POLICY LIMIT
"1 y 0 0 0 y 0 0 0
If yes, describe under
DESCRIPTION OF OPERATIONS below
[T]
DESCRIPTION OF OPERA17ONSILOCATIONS/ VEHIC(AUORD 101, Additional Remarks Schedule, may be attached if more space is required)
Those usual to the Insured's Operations_ Certificate Holder is an Additional
Insured per the Business Liability Coverage Form SS0008 attached to this
policy.
r`roTlrl!`ATr unl nGa CANCFLLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
City of Fort Collins, Colorado
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AU774ORIzmREPRESENTA77VE
Attn: : David Carey
1 PO BOX 580
FORT COLLINS, CO 80522
OO 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD