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Home My WebLink AboutCITY OF FORT COLLINS - INSURANCE CERTIFICATE (12)(10/31/2008) Ed Bonnette - 0210201034.pdf Page 1 j ACORD,M CERTIFICATE OF LIABILITY INSURANCE ID/3 M,DDIYYYYI /30/OB PRODUCER 1-303-773-9999 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1399 S. Fiddlers Green Cir ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 200 Greenwood village, CO 80111 Contact: Trac Paladins INSURERS AFFORDING COVERAGE NAIL k INSURED City Of Fort Collins INSURERA: Princeton Excess 4 Surplus Linea Ins 110786 D Box 580 Collins, CO 80522 UUVEHAUEJ THE POLICIES OF INSURANCE LISTEDBELOW HAVEBEEN ISSUED TOTHE 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 TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OSUCH POLICIES. AGGREGATE UMITSSHOWN MAYHAVE BEENREDUCED BYPAIDCLAIMS. L$R N TVP CE POLICYNUMBER POLICYEFFECTIVE DAT MMInNYY POLNnEXPIRATION RATE(M-10MYj LIMITS A GENERAL LIABILITY Nlh3RL000004801 04/15/08 04/15/09 EACH OCWRRENCE '500,000 % CO M"IRCIALGENL (ABILITY CIAIM$AIADEEPAOOCCUR A PREM1IISES Ea $ MED E%P An p'p� S X PERSONAL S AOVINJURY S SIR $SOD, 000 Per One. GENERAL AGGREGATE S500,000 GENLAGGREGATEUMITAPPI.IES PER PRODUCTS COHPIOPAGG $ POLICY PRO LCc AUTOMOBILELMUNJTY ANY AUTO CE LttBLI NHEOISINOLE LIMIT $ BODILY INJURY (P^ FO,SM) S AHOWNEOAUTOS SCHEDULED AUTOS BOgLV INJURY (Pa xCdxl) $ HIREDAVTOS W NO WNEO AUTOS PRaOPttCRTVDAMAGE S GARAGELIABILITY AUTO ONLY EAACCIDENT S OTHEEA ACC $ ANY AUTO $ AUTO ONLY AUTO ONLY'. qGG A EXCESSIUMBRELLALIA&LITY % OCCUR CLAIMS MADE NIMFOOOOOD0601 04/15/08 04/15/09 EACH OCCURRENCE $2,500,000 AGGREGATE 55,500,000 5 $ CEWCTIBLE $ RETENTION S WORKERS COMPENSATIONAND i STIATH OEM' ELL EACH ACGDENi 5 ANY PRRIMEMBEREXCTIEWE%ECUTIVE EA. DIBRASE EAEM1:PLOYEE 5 OFFILEWMEAIBEI£%CLVDEOi If ym ELL DISEASE POLICYLIMIi $ IALPROESI SPECIAL SPECIALPROVISIONSbXox OTHER DESCMPTIONOF OPERATI ON5 LOCATION& VEHICLES E%CLUSIONSADDED BY ENDORSEMENT SPECIAIPROVISIONS Princeton Excess 4 Surplus Lines Insurance Retained Limit Liability Policy Form includes coverage for General Liaiblity per endorsement RL 2032, Law Enforcement Liability per form RL 2015 and Wrongful Acts Liability per form RL 1000 LDEC 4 RL 1000 MCC. Retained Limit Policy Limit is Combined Single Limit per occurrence. Certificate holder is named as Additional Insured AS aspects Gene ral Liability as reguiredby their written contract with the Named Insured (Exhibit A, Scope of Work, between Ft Collins Police 4 Pawnee Sportsmena Center), per form RL 1000GL 01-02 regarding use of Outdoor Shooting Ranges 4 Clubhouses ace from 1/l/09 to 12/31/09. Pawnee Sportsmena Center LLC Attn: Richard Beck 41132 Weld County Rd #13 Fort Collins, CO 80524 USA ACORD25(2001/08) trapal SHOULD ANY OF THEASOVE DESCW RED POUOIESBE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE I SSUNG INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THELEFT.SUT FAILURETO DOSO SHALL IMPOSE NO OBLIGATIONOR UABIUTYOF ANY WIND UPON THE INSURER, ITS AGENTS OR (10/31/2008) Ed Bonnette - 0210201034.pdf Page 2 IMPORTANT if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 he certificate holder in lieu ofsuch endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.