HomeMy WebLinkAbout462114 ROCKY MOUNTAIN MEDIA CORP - INSURANCE CERTIFICATEACOCERTIFICATE OF LIABILITY INSURANCE
DATE //2018 )
08/03/03R"
018
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
CONTACT Karen George, CISR
NAME:
Flood and Peterson
PHONE (970) 356-0123 FAX (970) 330-1867
A/C No, Ext : (AtC. No
PO Box 578
E-MAIL KGeorge@floodpeterson.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
Greeley CO 80632
INSURER A: Massachusetts Bay Insurance Company
22306
INSURED
INSURER B : Plnnacol Assurance
41190
Rocky Mountain Student Media Corporation
INSURER C :
1101 Centre Ave Mall, Room 118
INSURER D :
INSURER E :
Fort Collins CO 80523
INSURER F :
COVERAGES CERTIFICATE NUMBER: CL188324678 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYVV
POLICY EXP
MM/DD/YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
S 1,000,000
15�DAMAGE
CLAIMS -MACE OCCUR
PREMISES (Ea occurrence
1,000.000
S
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ EXCLUDED
A
OD4-A997251-02
07/28/2018
07/28/2019
GEN'LAGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
S 2,000,000
❑PRO
JECT LOC
PRODUCTS-COMP/OPAGG
sPOLICY 2,000,000
S
OTHER
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident)
$
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
OD4-A997251-02
07/28/2018
07/28/2019
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
Per accident)
$AUTOS
HIRED H NON -OWNED
ONLY AUTOS ONLY
$
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
A
EXCESS LIAB
CLAIMS -MADE
OD4-A997251-02
07/28/2018
07/28/2019
DIED RETENTION S 0
S
B
WORKERS COMPENSATION Y / N
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE ElN
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
/ A
4125313
07/01/2018
07l01/2019
PER E
STATUTE ER
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
S 500,000
If ves, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named
insured.
GtK I It•IGAI t MULUtK
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522 X� ,(J[ F.,J_.C_
@ 1988-2015 ACORD CORPORATION- All rights reserved.
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