HomeMy WebLinkAboutROCKY MOUNTAIN RECREATION INC - INSURANCE CERTIFICATE 2021-2022��
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ROCKMOU-94
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
8/10/2021
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 paula Weeks
NAME:
Mountain West Insurance - Englewood
PHONE
3575 S Sherman Street (aic, No, eXc�: (303) 788-1916 �aic, No�: (303) 762-1733
Englewood, CO 80113 ADOR�Ess: paulaw@mtnwst.com
INSURED
Rocky Mountain Recreation Inc
PO Box 620411
Littleton, CO 80162
INSURER A: The Cincinnati Specialty Underwriters Insurence Company 13037
iNsuaea s: Cincinnati Insurance Com an 10677
iNsuRea c: Scottsdale Insurance Companv 41297
INSURER E :
INSURER F :
COVERAGES CERTIFICATE 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.
INSR TypE OF INSURANCE ADDL SUBR pOLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSD WVD MM DD YYY MM DD YYY
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ � rOOO�OOO
CLAIMS-MADE X OCCUR CSUOO4O6H2 8/10/2021 HI'I OIZO22 DAMAGE TO RENTED 'I OO�OOO
X PREMISES Ea occurrence $
MED EXP An one erson $ �,���
PERSONAL & ADV INJURY $ � rOOO�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000�000
POLICY �X jE � � LOC PRODUCTS - COMP/OP AGG $ 2,000�000
OTHER: $
B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ��OOO�OOO
Ea accident $
X ANY AUTO X EBA0178279 8/10/2021 8/10/2022 gODILY INJURY Per erson $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
X HIRED X NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident $
$
C+ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ � rOOO�OOO
EXCESS LIAB CLAIMS-MADE CXSO00%9%O 8/10/2021 HI'I OIZO22 AGGREGATE $
DED RETENTION $ Aggregate $ � �����0��
D WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ 4189358 8/1/2021 HI'I/ZO22 E.L. EACH ACCIDENT $ � rOOO�OOO
OFFICER/MEMBER EXCLUDED? N � A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ �,���,���
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
B Equipment Floater EBA0178279 8/10/2021 8/10/2022 300,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
8864 PLAYGROUND EQUIPMENT REDESIGN AND CONSTRUCTION
FOR LIBRARY PARK
City of Fort Collins, its officers, agents and employees are named as additional insured with respect to general liability and auto liability. The insurance
evidenced by this Certificate will not reduce coverage or limits and will not be cancelled, except after thirty (30) days written notice has been received by the
City of Fort Collins
HOL
City of Fort Collins
Financial Services - Purchasing Div
PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
��� ��'
ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
CSGA 43712 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU -
OPERATIONS AND COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. SECTION II - WHO IS AN INSURED is
amended to include as an additional insured
any person or organization when you and such
person or organization have agreed in writing
in a contract or agreement that such person or
organization be added as an additional insured
on your policy, but only with respect to "bodily
injury", "property damage" or "personal and
advertising injury" caused, in whole or in part,
by:
1. Your acts or omissions in the perform-
ance of your ongoing operations for the
additional insured;
2. The acts or omissions of those acting on
your behalf in the performance of your
ongoing operations for the additional in-
sured; or
3. "Your work" performed for the additional
insured and included in the "products-
completed operations hazard".
If not specified otherwise in the written con-
tract or agreement, a person's or organiza-
tion's status as an additional insured under this
endorsement ends one year after your opera-
tions for that additional insured are completed.
The written contract or agreement must be
currently in effect or become effective during
the term of this Coverage Part. The contract or
agreement must be executed prior to the "bod-
ily injury", "property damage" or "personal and
advertising injury" to which this endorsement
perta i ns.
H owever:
1. The insurance afforded to such additional
insured only applies to the extent permit-
ted by law; and
2. If coverage provided to the additional in-
sured is required by a contract or agree-
ment, the insurance afforded to such ad-
ditional insured will not be broader than
that which you are required by the con-
tract or agreement to provide for such ad-
ditional linsured.
B. With respect to the insurance afforded to
these additional insureds, the following addi-
tional exclusions apply:
This insurance does not apply to:
1. "Bodily injury", "property damage" or "per-
sonal and advertising injury" arising out of
the rendering of, or the failure to render,
any professional architectural, engineer-
ing or surveying services, including:
a. The preparing, approving, orfailing to
prepare or approve, maps, shop
drawings, opinions, reports, surveys,
field orders, change orders or draw-
ings and specifications; or
b. Supervisory, inspection, architectural
or engineering activities.
2. "Bodily injury" or "property damage" aris-
ing out of "your work" for which a consoli-
dated (wra�up) insurance program has
been provided by the prime contrac-
tor/project manager or owner of the con-
struction project in which you are involved.
3. "Bodily injury", "property damage" or "per-
sonal and advertising injury" to any em-
ploy�ee of you or to any obligation of the
additional insured to indemnity another
because of damages arising out of such
injury.
Includes copyrighted material of ISO
CSGA437 1213 Properties, Inc., with its permission. Page 1 of 2
4. "Bodily injury", "property damage" or "per-
sonal and advertising injury" for which the
Named Insured is afforded no coverage
under this policy of insurance.
C. With respect to the insurance afforded to
these additional insureds, SECTION III - LIM-
ITS OF INSURANCE is amended to include:
The limits applicable to the additional insured
are those specified in the written contract or
agreement or in the Declarations of this Cov-
erage Part, whichever is less. If no limits are
specified in the written contract or agreement,
the limits applicable to the additional insured
are those specified in the Declarations of this
Coverage Part. The limits of insurance are in-
clusive of and not in addition to the limits of in-
surance shown in the Declarations.
D. With respect to the insurance afforded to
these additional insureds, SECTION IV -
COMMERCIAL GENERAL LIABILITY CON-
DITIONS, 4. Other Insurance is amended to
include:
Any coverage provided herein will be excess
over any other valid and collectible insurance
available to the additional insured whether
primary, excess, contingent or on any other
basis unless you have agreed in a written con-
tract or written agreement executed prior to
any loss that this insurance will be primary.
This insurance will be noncontributory only if
you have so agreed in a written contract or
written agreement executed prior to any loss
and this coverage is determined to be primary.
Includes copyrighted material of ISO
CSGA437 12 13 Properties, Inc., with its permission. Page 2 of 2
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CinciPlus°
BUSINESS AUTO XC+°
(EXPANDED COVERAGE PLUS)
ENDORSEMENT
This endorsement modifies insurance provided by the following:
BUSINESS AUTO COVERAGE FORM
With respect to the coverage provided bythis endorsement, the pro�isions of the Coverage Form apply unless
modified by this endorsement.
A. Blanket Wai�er of Subrogation
SECTION IV - BUSINESS AUTO CONDI-
TIONS, A. Loss Conditions, 5. Transfer of
Rights of Recovery Against Others to Us is
amended by the addition of the following:
We waive any right of recovery we may have
against any person or organization because of
payments we make for "bodily injury" or
"property damage" arising out of the operation
of a covered "auto" when you have assumed
liability for such "bodily injury" or "property
damage" under an "insured contract", provid-
ed the "bodily injury" or "property damage" oc-
curs subsequent to the execution or the "in-
sured contract".
B. Noncontributory Insurance
SECTION IV - BUSINESS AUTO CONDI-
TIONS, B. General Conditions, 5. Other In-
surance c. is replaced by the following:
c. Regardless of the provisions of Par-
agraph a. above, this Coverage
Form's Liability Coverage is primary
and we will not seek contribution
from any other insurance for any lia-
bility assumed under an "insured
contract" that requires liability to be
assumed on a primary noncontributo-
ry basis.
C. Additional Insured by Contract
SECTION II - LIABILITY COVERAGE, A.
Coverage, I. Who is an Insured is amended
to include as an insured any person or organi-
zation with which you have agreed in a valid
written contract to provide insurance as is af-
forded by this policy.
This provision is limited to the scope of the
valid written contract.
This provision does not apply unless the valid
written contract has been:
1. Executed prior to the accident causing
"bodily injury" or "property damage"; and
2. Is still in force at the time of the "accident"
causing "bodily injury" or "property dam-
age".
D. Employee Hired Auto
1.
2.
Changes in Liability Co�erage
The following is added to the Section II -
Liability Coverage, A. Co�erage, 1.
Who is an Insured:
An "employee" of yours is an "insured"
while operating an "auto" hired or rented
under a contract or agreement in that
"employee's" name, with your permission,
while performing duties related to the
conduct of your business.
Changes in General Conditions
SECTION IV - BUSINESS AUTO CON-
DITIONS, B. General Conditions, 5.
Other Insurance is amended by replac-
ing Paragraph 5.b. with the following:
b. For Hired Auto Physical Damage
Coverage the following are deemed
to be covered "autos" you own:
{1) Any covered "auto" you lease,
hire, rent or borrow; and
{2) Any covered "auto" hired or
rented byyour "employee" under
a contract in that individual "em-
ployee's" name, with your per-
mission, while performing duties
related to the conduct of your
business.
Includes copyrighted material of ISO
AA 288 Q1 16 Properties, Inc., with its permission. Page 1 of 4
Howe�er, any "auto" that is leased,
hired, rented or borrowed with a dri�er
is not a co�ered "auto".
E. Audio, Visual and Data Electronic Equip-
ment
SECTION III - PHYSICAL DAMAGE COV-
ERAGE, C. Limit of Insurance is amended
by adding the following:
4. The most we will pay for all "loss" to au-
dio, �isual or data electronic equipment
and any accessories used with this
equipment as a result of any one "acci-
dent" is the lesser of:
a. The actual cash value of the dam-
aged or stolen property as of the time
of the "accident";
b. The cost of repairing or replacing the
damaged or stolen property with oth-
er property of like kind and quality; or
c. $2,500.
Pro�ided the equipment, at the time of the
"loss" is:
a. Permanently installed in or upon the
co�ered "auto" in a housing, opening
or other location that is not normally
used by the "auto" manufacturer for
the installation of such equipment;
b. Removable from a permanently in-
stalled housing unit as described in
Paragraph 2.a. abo�e; or
c. An integral part of such equipment.
F. Who is an Insured - Amended
SECTION II - LIABILITY COVERAGE, A.
Coverage, 1. Who is an Insured is amended
by adding the following:
The following are "insureds":
1. Any subsidiary which is a legally incorpo-
rated entity of which you own a financial
interest of more than 50% of the �oting
stock on the effective date of this cover-
age form.
However, the insurance afforded by this
provision does not apply to any subsidiary
that is an "insured" under any other au-
tomobile liability policy, or would be an
"insured" under such policy but for termi-
nation of such policy or the exhaustion of
such policy's limits of insurance.
2. Any organization that is newly acquired or
formed by you and o�er which you main-
tain majority ownership. The insurance
provided by this provision:
a. Is effective on the date of acquisition
or formation, and is afforded for 180
days after such date;
b. Does not apply to "bodily injury" or
"property damage" resulting from an
"accident" that occurred before you
acquired or formed the organization;
c. Does not apply to any newly acquired
or formed organization that is a joint
venture or partnership; and
d. Does not apply to an insured under
any other automobile liability policy,
or would be an insured under such a
policy but for the termination of such
policy or the exhaustion of such poli-
cy's limits of insurance.
3. Any of your "employees" while using a
covered "auto" in your business or your
personal affairs, provided you do not own,
hire or borrow that "auto".
G. Liability Coverage E�ctensions - Supple-
mentary Payments - Higher Limits
SECTION II - LIABILITY COVERAGE, A.
Co�erage, 2. Coverage Extensions, a. Sup-
plementary Payments is amended by:
1.
�
Replacing the $2,000 Limit of Insurance
for bail bonds with $4,000 in (2); and
Replacing the $250 Limit of Insurance for
reasonable expenses with $500 in (4).
H. Amended Fellow Employee Exclusion
SECTION II - LIABILITY COVERAGE, B. Ex-
clusions, 5. Fellow Employee is modified as
follows:
Exclusion 5. Fellow Employee is deleted.
I. Hired Auto - Physical Damage
If hired "autos" are co�ered "autos" for Liability
Coverage, then Comprehensi�e and Collision
Physical �amage Co�erages as pro�ided un-
der SECTION III - PHYSICAL DAMAGE
COVERAGE of this Coverage Part are ex-
tended to "autos" you hire, subject to the fol-
lowing:
1. The most we will pay for "loss" to any
hired "auto" is $50,000 or the actual cash
�alue or cost to repair or replace, which-
ever is the least, minus a deductible.
2. The deductible will be equal to the largest
deductible applicable to any owned "auto"
for that coverage, or $1,000, whiche�er is
less.
3. Hired Auto - Physical Damage co�erage
is excess over any other collectible insur-
ance.
Includes copyrighted material of ISO
AA 288 Q1 16 Properties, Inc., with its permission. Page 2 of 4
4. Subject to the abo�e limit, deductible, and
excess pro�isions we will pro�ide cover-
age equal to the broadest coverage appli-
cable to any co�ered "auto" you own in-
sured under this policy.
K. Transportation Expense - Higher Limits
SECTION III - PHYSICAL DAMAGE COV-
ERAGE, A. Coverage, 4. Coverage E�en-
sions is amended by replacing $20 per day
with $50 per day, and $600 maximum with
$1,500 maximum in E�ension a. Transpor-
tation Expenses.
Co�erage includes loss of use of that hired au-
to, pro�ided it results from an "accident" for
which you are legally liable and as a result of
which a monetary loss is sustained by the �•
leasing or rental concern. The most we will
pay for any one "accident" is $3,000.
If a limit for Hired Auto - Physical �amage is
shown in the Schedule, then that limit replac-
es, and is not added to, the $50,000 limit indi-
cated abo�e.
J. Rental Reimbursement
SECTION III - PHYSICAL DAMAGE is
amended by adding the following:
1. We will pay for rental reimbursement ex-
penses incurred by you for the rental of
an "auto" because of a"loss" to a covered
"auto". Payment applies in addition to the
otherwise applicable amount of each co�-
erage you ha�e on a covered "auto". No
deductible applies to this co�erage.
2. We will pay only for those expenses in-
curred during the policy period beginning
24 hours after the "loss" and ending, re-
gardless of the policy's expiration, with
the lesser of the following number of
days:
a. The number of days reasonably re-
quired to repair the covered "auto". If
"loss" is caused by theft, this number
of days is added to the number of
days it takes to locate the co�ered
"auto" and return it to you; or
b. 30 days.
3. Our payment is limited to the lesser of the
following amounts:
a. Necessary and actual expenses in-
curred; or
b. $50 per day.
4. This coverage does not apply while there
are spare or reserve "autos" available to
you for your operations.
1. SECTION III - PHYSICAL DAMAGE
COVERAGE, C. Limit of Insurance is
deleted in its entirety and replaced by the
following, but only for pri�ate passenger
type "autos" with an original loan or lease,
and only in the event of a"total loss" to
such a pri�ate passenger type "auto":
a. The most we will pay for "loss" in any
one "accident" is the greater of:
(1) The amount due under the terms
of the lease or loan to which
your co�ered private passenger
type "auto" is subject, but will not
include:
(a) O�erdue lease or loan pay-
ments;
(b) Financial penalties imposed
under the lease due to high
mileage, excessive use or
abnormal wear and tear;
(c) Security deposits not re-
funded by the lessor;
(d) Costs for extended warran-
ties, Credit Life Insurance,
Health, Accident or Disabil-
ity Insurance purchased
with the loan or lease; and
(e) Carry-o�er balances from
pre�ious loans or leases, or
5. We will pay under this coverage only that
amount of your rental reimbursement ex- (2) Actual cash �alue of the stolen
penses which is not already pro�ided for or damaged property.
under SECTION III - PHYSICAL DAM- b, An adjustment for depreciation and
AGE COVERAGE, A. Coverage, 4. physical condition will be made in de-
Coverage Extensions. termining actual cash �alue at the
time of "loss".
Includes copyrighted material of ISO
AA 288 Q1 16 Properties, Inc., with its permission. Page 3 of 4
Airbag Co�erage
SECTION III - PHYSICAL DAMAGE COV-
ERAGE, B. Exclusions, 3.a. is amended by
adding the following:
However, the mechanical and electrical
breakdown portion of this exclusion does not
apply to the accidental discharge of an airbag.
This coverage for airbags is excess over any
other collectible insurance or warranty.
M. Loan or Lease Gap Co�erage
2. SECTION V- DEFINITIONS is amended
by adding the following, but only for the
purposes of this Loan or Lease Gap
Coverage:
"Total loss" means a"loss" in which the
cost of repairs plus the sal�age �alue ex-
ceeds the actual cash value.
N. Glass Repair - Waiver of Deductible
SECTION III - PHYSICAL DAMAGE COV-
ERAGE, D. Deductible is amended by adding
the following:
No deductible applies to glass damage if the
glass is repaired in a manner acceptable to us
rather than replaced.
O. Duties in the E�ent of an Accident, Claim,
Suit or Loss - Amended
SECTION IV - BUSINESS AUTO CONDI-
TIONS, A. Loss Conditions, 2. Duties in the
Event of Accident, Claim, Suit or Loss, a. is
amended by adding the following:
This condition applies only when the "acci-
dent" or "loss" is known to:
1. You, if you are an individual;
2. A partner, if you are a partnership;
3. An executive officer or insurance manag-
er, if you are a corporation; or
4. A member or manager, if you are a lim-
ited liability company.
P. Unintentional Failure to Disclose Hazards
SECTION IV - BUSINESS AUTO CONDI-
TIONS, B. General Conditions, 2. Conceal-
ment, Misrepresentation or Fraud is
amended by adding the following:
However, if you unintentionally fail to disclose
any hazards existing on the effective date of
this Coverage Form, we will not deny co�er-
age under this Co�erage Form because of
such failure.
Q. Mental Anguish Resulting from Bodily Inju-
rY
SECTION V- DEFINITIONS, C. "Bodily inju-
ry" is deleted in its entirety and replaced by
the following:
"Bodily injury" means bodily injury, sickness or
disease sustained by a person, including men-
tal anguish and death sustained by the same
person that results from such bodily injury,
sickness or disease. "Bodily injury" does not
include mental anguish or death that does not
result from bodily injury, sickness or disease.
R. Co�erage for Certain Operations in Con-
nection with Railroads
With respect to the use of a covered "auto" in
operations for or affecting a railroad:
1. Section V- Definitions, H. "Insured con-
tract", 1.c. is amended to read:
c. An easement or license agreement;
2. Section V- Definitions, H. "Insured con-
tract", 2.a. is deleted.
Includes copyrighted material of ISO
AA 288 Q1 16 Properties, Inc., with its permission. Page 4 of 4