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HomeMy WebLinkAboutRAM INTERVATIONAL DBA CB & POTTS - INSURANCE CERTIFICATE►c R CERTIFICATE OF LIABILITY INSURANCE DATE 04/26/DD/YWY) 6/10 PRODUCER 1-253-627-7183 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 P.O. Box 2925 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tacoma, WA 98401-2925 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A:UNIGARD INS CO 25747 Ram International 1, LLC INSURERB:ZURICH AMERICAN INS CO 16535 10013 - 59th Avenue SW. INSURERC: Tacoma, WA 98498 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD'L INSR PE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MMIDD/YYYY1 LIMITS A GENERAL LIABILITY CM012524 05/01/10 05/01/11 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY _xI DAMAGEO NTED PREMISES Ea occurrence $ 100,000 CLAIMS MADE F OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X $5,000 PD Ded. GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO- JECT F X LOC AUTOMOBILE X LIABILITY ANY AUTO CM012524 05/01/10 05/01/11 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ JA X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY CU013619 05/01/10 05/01/11 EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE - AGGREGATE $ 5, 000 , 000 $ DEDUCTIBLE $ X RETENTION $ 10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ /M OFFICEREMBER EXCLUDED? WC5098977 _07/01/09 07/01/10 X WCSTATU- OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1, 000 , 000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000- SPECIAL PROVISIONS below OTHER A Liquor Liability CM012524 05/01/10 05/01/11 Per Occ 1,000,000 A Employers Liab - Stop Gap CM012524 05/01/10 05/01/11 Aggregate 2,000,000 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: Collindals Golf Course - Restaurant/Snack Bar Concession Agreement Named Insured Includes - Collindale 57,L.L.C. d/b/a/ C.B.& Potts The City, its officers, agents and employees are named as Additional Insured per policy form 140365 (03/86). CtK I It-ICA I t HULUtK CANUELLA I ION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The City of Fort Collins, Colorado DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 300 LaPorte Avenue IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Fort Collins, CO 80521 AUTHORIZED REPRESENTATIVE USA ACUKU Zb (ZUU9/U1) asnwinitac © 1988-2009 ACORD CORPORATION. All rights reserved. 15411563 The ACORD name and logo are registered marks of ACORD 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 the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance 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. ACORD 25 (2009/01) 3:4