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Home My WebLink About143207 NEW BELGIUM BREWING CO - INSURANCE CERTIFICATE (6)ACORD, CERTIFICATE OF LIABILITY INSURANCE 12/ 1 /2017 DATE(MM/DDr7) 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 CONTACT NAME: FAX A/C No Ext : AC' C No): 8110 E. Union Avenue Suite 700 Denver CO 80237 E-MAIL ADDRESS: INSURER 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 Com anv 22292 1350260 500 Linden Street Fort Collins, CO 80524 INSURER C : Plnnacol 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 INS SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y 1 N ZZ48945648-06 1 12/1/2016 12/1/2017 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 1,000,000 MED EXP An one person)10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY❑ JE� LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO AAUTOS ONLY SCHEDULED AUTOS AUTOS ONLY X NON-OWNED ONLY N N AH4 8902695-06 12/l/2016 12/l/2017 (COaBINEDtSINGLE LIMIT $ 1 000,000 X BODILY INJURY (Per person) $ }(}(X}(XXX X BODILY INJURY (Per accident $ }(}(]{}(XXX X Pe'accidentPER DAMAGE $ XXXXXXX Comp/Coll Ded. $ XXXXXXX B X UMBRELLA LIAR EXCESS LIAR I }{ OCCUR CLAIMS -MADE N N UH48903631-06 12/1/2016 12/1/2017 EACH OCCURRENCE $ 20 000,000 AGGREGATE $ 20 000,000 DED RETENTION $ $ XXXXXXX �- D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) f yes, Jescnbe under DESCRIPTION OF OPERATIONS below N / A N 4197188 - Colorado WC 103693700 - AOS 12/l/2016 12/1/2016 12/l/2017 12/l/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 Z.Z48945648-06 12/l/2016 12/l/2017 $1,000,000: Each Common Cause $2,000,000: Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED. RE — Event: Tour de Fat Fort Collins, Date and Times: Thursday, September 1, 2016 from 5pm to 1 Opm — Friday, September 2, 2016 from 6am to 1 Opm — Saturday, September 3, 2016 from 6am to I I 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 CANCELLATION See Attachment 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 ar% � I, ACORD 25 12D16/031 ©19 8 2015 ACOI CORPO TION. All riohts reserved The ACORD name and logo are registered marks of ACORD