HomeMy WebLinkAboutTHE SERTOMA CLUB OF FORT COLLINS SERVICE CLUB - INSURANCE CERTIFICATEFOUNDERS INSURANCE COMPANYSM
A MULTIPLE LINE STOCK COMPANY
11 I 1 EAST TOUHY AVENUE, SUITE 300, DES PLAINES, IL 60018
(800)972-8778 / Fax (847) 795-0080 Liquor Liability
New Business
AGENCY ACCT EFFECTIVE
Declaration
05/27/17
POLICY NUMBER
FROM POLICY PERIOD TO
ELCO100078
05/27/17 05/29/17
12:01 AM STANDARD TIMEJ
2980 -0004
NAMED INSURED AND ADDRESS
PRODUCER
THE SERTOMA CLUB OF FORT
COLLINS SERVICE CLUB
P.O. BOX 1083
FORT COLLINS CO 80521
ALL RISKS, LTD
ALL RISKS, LTD
11811 N. TATUM
PHOENIX
(602) 494-7200
OF ARIZONA
SUITE #4010
AZ 85028
THE NAMED INSURED IS THE SERTOMA CLUB OF FORT
COVERAGES
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS/POLICIES
PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO
COVERAGE PART/POLICY ATTACHED
COMMERCIAL LIQUOR LIABILITY COVERAGE .......................
MINIMUM AND DEPOSIT PREMIUM ................................
FOR WHICH A
ADJUSTMENT.
PREMIUM
$1,017.00
$1,017.00
FORMS THAT APPLY TO APPLICABLE COVERAGE PARTS
ENDORSEMENT NO EDITION DATE DESCRIPTION
*CO-CSL 01-11 Colorado Liquor Liability
Coverage Part
ADDITIONAL INSURED(S)
AI# INTEREST NAME AND ADDRESS
1 PROPERTY OWNER CIVIC CENTER PARK
300 LAPORTE AVENUE
FORT COLLINS CO 80522
2 SPONSOR REALITIES FOR CHILDREN
1610 S. COLLEGE DRIVE
FORT COLLINS CO 80524
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT
COVERAGE PARTS/POLICIES ATTACHED, WE AGREE WITH YOU TO
DESCRIBED THEREIN.
Special Interest WWW.FOUNDERSINSURANCE.COM
TO ALL THE TERMS OF THE
PROVIDE THE INSURANCE
DATE 05/02/17
FOUNDERS INSURANCE COMPANYsM
A MULTIPLE LINE STOCK COMPANY
11 1 1 EAST TOUHY AVENUE, SUITE 300, DES PLAINES, IL 60018
(800)972-8778 / Fax (847) 795-0080 Liquor Liability
New Business Declaration
AGENCY ACCT
EFFECTIVE 05/27/17
POLICY NUMBER
FROM POLICY PERIOD TO
ELCO100078
05/27/17 05/29/17
12:01 AM STANDARD TIMEJ
2980
-0004
NAMED INSURED AND ADDRESS
PRODUCER
THE SERTOMA CLUB OF FORT
ALL RISKS, LTD
COLLINS SERVICE CLUB
ALL RISKS, LTD OF ARIZONA
P.O. BOX 1083
11811 N. TATUM SUITE #4010
FORT COLLINS CO 80521
PHOENIX AZ 85028
(602) 494-7200
X. xxxx-
LOCATION ADDRESS(ES)
LOCATION 01
OLD TOWN FORT COLLINS PUBLIC P
CIVIC CENTER PARK, 300 LAPORTE
FORT COLLINS CO 80521
COVERAGES
DESCRIPTION: Charitable Fundraisers
or Events
LOC ITEM TERR CLASS BASIS TYPE DED AMT EXPOSURE
PREMIUM
1 1 001 4483
5000
$977
COVERAGE PER PERSON
OCCURRENCE AGGREGATE
Combined Single Limit
1,000,000 1,000,000
ADDITIONAL FORMS AND ENDORSEMENTS APPLICABLE
TO THIS COVERAGE PART
ONLY
NUMBER DATE
LOC ITEM LIMIT
PREMIUM
*CG 21 73 01-15 Exclusion - Terrorism
1 1
*CG 21 87 01-15 Cond. Exclusion Terrorism
1 1
*CO 20 26 07-04 Addl Insd Designate Pers 1 1
$40.00
MINIMUM AND DEPOSIT PREMIUM ..................................
$1,017.00
Special Interest