HomeMy WebLinkAbout143207 NEW BELGIUM BREWING CO - INSURANCE CERTIFICATE (5)ACORD, CERTIFICATE OF LIABILITY INSURANCE 12/1/2017
DATE(MM/DD/YYYY)
12/1/2016
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 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 Lockton Companies
CONT CT
NAME:
8110 E. Union Avenue
Suite 700
Denver CO 80237
PRONE FAX
A/C No Ext : A/C No):
E-MAIL
ADDRESS:
IN RER S AFFORDING COVERAGE
NAIC #
(303) 414-6000
INSURER A: The Hanover American Insurance Company
36064
INSURED New Belgium Brewing Company, Inc.
INSURER B: The Hanover Insurance CommCommy
22292
1350260 500 Linden Street
Fort Collins, CO 80524
INSURER C : Pinnacol Assurance Company
41 190
INSURER D : American Zurich Insurance Company
40142
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 13354403 REVISION NUMBER: XXXXXXX
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
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FRI OCCUR
Y
N
ZZ48945648-06
12/1/2016
12/1/2017
EACH OCCURRENCE
1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
1,000,000
MED EXP (Any oneperson)
10,000
PERSONAL & ADV INJURY
$ 1,000,000
L AGGREGATE LIMIT APPLIES PER:
POLICY❑JECT LOC
P'OTHER:
GENERAL AGGREGATE
$ 2 00O 000
PRODUCTS - COMP/OP AGG
$ 2000 000
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED AUTOS ONLY AUTOS
AUTOS ONLY X NON-OWNED
ONLDY
N
N
AH4 8902695-06
12/1/2016
12/1/2017
(CEO,aCcld DtswGLE LIMIT
$ 1,000 000
X
BODILY INJURY (Per person)
$ XXXXXXX
X
BODILY BODILY INJURY (Per accident
$ XXXXXXX
X
Peer accRdTY DAMAGE
$ XXXXXXX
Comp/Coll Ded.
$ See Below
B
}�'
UMBRELLA LIAB
EXCESS LIAB
]{
OCCUR
CLAIMS -MADE
N
N
UH48903631-06
12/1/2016
12/1/2017
EACH OCCURRENCE
$ 20 000,000
AGGREGATE
$ 20,000 000
DIED RETENTION $
$ XXXXXXX
C
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE �
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
N/A
N
4197188 WC1036-Colorado
WC103693700-Acts
12/1/2016
12/1/2016
12/1/2017
12/I/2017
X STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
1,000,000
E.L. DISEASE - POLICY LIMIT
1 ,000 000
A
Liquor Liability
N
N
ZZ48945648-06
12/1/2016
12/1/2017
$1,000,000: Each Common Cause
$2,000,000: Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Comp/Coll Deductible: $1,000/$2,500 Heavy Trucks. RE — Event: 'four de Fat Fort Collins, Date and Times Thursday, September 1, 2016 from 5pm to I Opm —
Friday, September 2, 2016 from 6am to 1 Opm — Saturday, September 3, 2016 from 6am to I 1 pm. The City of Fort Collins, Its officers, agents, employees and
volunteers are included as Additional Insured as respects General Liability if required by written contract.
CERTIFICATE HOLDER GANGELLA I IUN gee Httacnment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
13354403 AUTHORIZED REPRESENTATIVE
City of Fort Collins
Attn: Risk Management
PO Box 580
Fort Collins, CO 80522-0580 f
ernRn 7F r7niA/nnt Ce�1 8 2015 ACORD CORPO TION. All rights reserved
The ACORD name and logo are registered marks of ACORD