HomeMy WebLinkAboutRAM INTERNATIONAL 1 - INSURANCE CERTIFICATE�`� o® CERTIFICATE OF LIABILITY INSURANCE
ATE
O6/29/2011
D06/29IDOI11
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 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 endorsements .
PRODUCER 1-253-627-7183
Arthur J. Gallagher Risk Management Services, Inc.
CONTACT
NAME:
PHONE FAX
INC, No,. Eat: INC, No),
P.O. Box 2925
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAICa
Tacoma, WA 98601-2925
INSURER A: SPARTA INS CO
20613
INSURED
INSURER B :
Bam International 1, LLC
INSURER C :
INSURER D:
10013 - 59th Avenue SW.
INSURER E:
Tacoma, WA 98498-
INSURER F :
COVERAGES CERTIFICATE NUMBER: 22022213 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 ADOL SUBR POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MMIDO MIN
GENERAL LIABILITY
EACH OCCURRENCE
$
PREMISES FEa occurrence
$
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F7 OCCUR
MED EXP(AnYone person)
$
PERSONAL $ ADV INJURY
S
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - CONNOR AGG
S
POLICY I PRa I LOC
$
OMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident)
BODILY INJURY (Per person)
$
ANY AUTO
R
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
S
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Paramident
$
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
AGGREGATE
S
EXCESS LIAB
CLAIMS -MADE
DED RETENTION$
$
A
WORKERS COMPENSATION
ANDEMPLOYERS' LIABILITY Y/N
ANY PROPRIETORIPARTNERIEXECUTIVE
O<OWX00012
07/01/1
07/Ol/12
X WC STATU- OTH-
CA EACH ACCIDENT
$ 1,000,000
OFFICERIMEMBER EXCLUDEDI ❑
N/A
E.L.. DISEASE -EA EMPLOYE
S 1,000,000
(Myandate, In NH)
DESCRIPTION OF( below
E.L. DISEASE -POLICY LIMIT
S 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Re: Collindale Golf Course - Restaurant/Snack Bar/Concession Agreement
Named Insured includes: Collindale 57 LLC d/b/a CB 6 Potts
Evidence of WC Insurance
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
The City of Fort Collins, Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
300 LaPorte Avenue AUTHORIZED REPRESENTATIVE AA
Fort Collins, CO 80521 /w
USA
1988-2010 ACORD CORPORATION. All right , reserve
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
jlewis
22022213
3,4
Arthur J. Gallagher Risk Management Services, Inc.
P.O. Box 2925 E B IX B P O
Tacoma, WA 98401-2925
USA
The City of Fort Collins, Colorado
300 LaPorte Avenue
Fort Collins, CO 80521
USA 9a49: 153
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