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Home My WebLink AboutGREENSHIRE STABLES LLC - INSURANCE CERTIFICATE (3)..;� RENEWAL OF FSL-4161751-92 erlcdn Bankers POLICY DECLARATIONS * * * EFFECTIVE It15€ICI€Company�� 12:01 AM STANDARD TIME AT MAILING Q ADDRESS OF THE INSURED 222 S. 15th Street, Suite 600S, Omaha, NE 68102 POLICY NUMBER FROM POLICY PERIOD To POLICY TYPE AGENCY PAGE 1 FSL4161751 11/15/2011 11/15/2012 FARMOWNER OFC9001-0015 OF 3 NAMED INSURED AND MAILING ADDRESS AGENT/ACCOUNT GREENSHIRE STABLES LLC GOETZ INSURORS INC SEE NAMED INSURED CONTINUATION 227 MAIN ST 4205 S COUNTY ROAD 7 PO BOX 190 FORT COLLINS, CO 80525-9610 FORT MORGAN, CO 80701-2106 0015 CARRUTH, ROBERT J. The Insured is: ® An Individual ❑ A Joint Venture ❑ A Partnership ❑ An Organization (Other Than A Partnership or Joint Venture) ❑ A Limited Liability Company Insured premises: Item No. Description Location 1 4205 S COUNTY ROAD 7, LARIMER COUNTY, FORT COLLINS, CO 80525 *** See GL-91 for Additional Farm Premises *** This replaces all previously issued Policy Declarations, if any. This Policy applies only to accidents, occurrences, or losses which happen during the Policy term shown above. This Policy applies only to those coverages below for which a limit of liability or premium charge is shown. "Our' limit of liability for each coverage shall be not more.than the amount stated for such coverage, subject to all the "terms" of this Policy. Property Coverages A. Residence B. Related Private C. Personal D. Add'l Living Cost Structures Property or Fair Rental Value Limit of Liability $ 507,394 $ 50,738 $ 355,175 $ 101,479 E. Farm Barns, Buildings F. Scheduled Farm G. Unscheduled Farm and Structures Personal Property Personal Property Limit of Liability $ 277,552 $ 10,000 $ 125,000 Coverage F: ❑ Pro Rata Distribution Clause ® Coinsurance Clause Coinsurance Percentage Coverage G: ❑ _ Coinsurance Percentage -- This replaces the percentage under Other Limitations -- Coverage G. Additional Property Not Covered Under Coverage G: Deductible: $ 1,000 All Perils Except: Refer to deductible endorsement. A2301(1)-1095 A2301(1).meta . monger a AswrantGrovP 4rrierican Bankers Insurance Company of Florida 222 S. 15th Street, Suite 600S, Omaha, NE 68102 RENEWAL OF FSL-4161751-92 POLICY DECLARATIONS * * * EFFECTIVE 12:01 AM STANDARD TIME AT MAILING ADDRESS OF THE INSURED POLICY NUMBER I FROM POLICY PERIOD TO I POLICY TYPE I AGENCY I PAGE 2 FSL 4161751 11/15/2011 I 11/15/2012 IFARMOWNER OFC9001-0015 OF 3 This Policy is exteneded to cover the following activities, in addition to "farming": "Farming" is extended to include: Equine related activities as classified elsewhere on the Declarations and for which a premium is shown. NAMED INSURED CLAUSE: GREENSHIRE STABLES LLC, HOMER CRAIG NORRIS, BARBARA LYNN WEST NORRIS Commercial Liability Each Occurrence Limit Coverage $1,000,000 General Aggregate Limit (other than Products/ Completed Work) $2,000,000 Fire Legal Liability Limit $50,000 /per occurrence Extra Expense Coverage -- Limit of Liability $ POLICY LIMIT The following "limits" replace those in the Policy for the coverages noted below: Incidental Property Coverages -- Forms FO-1 FO-2 FO-3 FO-4, or FO-5 Fire Department Service Charge Credit Card, Forgery, and Counterfeit Money Outdoor Antennas Well Pumps Private Power and Light Poles Refrigerated Food Spoilage Tenant's Improvements Incidental Property Coverages -- Form FO-6 Fire Department Service Charge Property in the Care of a Common or Contract Carrier Signs Glass Breakage in Cabs Farm Operations Records Medical Payments to Others $5,000 per person Products/Completed Work Hazard Aggregate Limit $2,000,000 Limit of Liability POLICY LIMIT $ POLICY LIMIT $ POLICY LIMIT $ POLICY LIMIT $ POLICY LIMIT $ POLICY LIMIT $ NOT COVERED POLICY LIMIT $ POLICY LIMIT $ POLICY LIMIT $ POLICY LIMIT $ POLICY LIMIT A2301 B(1)-1095 member of AowrantGroup- A230113(1).meta 27 AF merican Bankers InSUIXT1.1 Company of Florida 1 222 S. 15th Street, Suite 600S, Omaha, NE 68102 RENEWAL OF FSL-4161751-92 POLICY DECLARATIONS * * * EFFECTIVE 12:01 AM STANDARD TIME AT MAILING ADDRESS OF THE INSURED MORTGAGEE INFORMATION MORTGAGEEE NAME AND MAILING ADDRESS 1) BANK OF AMERICA, CLIENT 133, PO BOX 1675, CORAOPOLIS, PA 15108-1675 2) FIRST NATIONAL BANK, 205 W OAK ST, FORT COLLINS, CO 80521 LOAN NUMBER 1) 1 ST MORTGAGEE, 2) 2ND MORTGAGEE LIENHOLDER/LOSS PAYEE INFORMATION SECURED PARTY NAME AND MAILING ADDRESS LOAN NUMBER Commercial Liability If this is checked coverage does not apply. All known exposures at the beginning of the Policy period have been identified below. Classification Code Rating Basis Rate Premium Stables, Boarding 16402 VARIOUS INCLUDED $ 683 SUBJECT TO THE FOLLOWING FORMS AND ENDORSEMENTS AF-9378SM 1095, AF-9379SM 1095, B8301E0403, B8302E0403, B8318E0205, B8337E0605, B8341E0905, B8344EI 109, 138371E1107, FO-20 1.0, FO-200 1.0, FO-216 1.0, FO-217 1108, FO-3 1.0, FO-309 1.1, FO-341 1.0, FO-360 1.0, FO-362 1.0, FO-368 0699, FO-55 1.0 FO-6 1.0, FO-61 1.2, FO-675 1006, FO-738 0800, GL-610 2.0, GL-612 1.0, GL-73 2.0, GL-81 2.0, GL-810 0305, GL-83 2.0 GL-841 1.0 GL-9 1.0 GL-904 2.0 GL-91 1.0 M7000G-0508 TOTAL POLICY PREMIUM: COUNTERSIGNED: By: AUTHORIZED AGENT $5,787 $5,787 DATE A2301C(1)-1095 A2301C(1).meta member of AssUIantGroup AAIS This endorsement changes the Commercial GL-841 Liability Coverages provided by this policy Ed. 1.0 -- PLEASE READ THIS CAREFULLY -- ADDITIONAL INSURED DESIGNATED PARTY Schedule The information required below may be shown on a separate schedule or supplemental Declarations.) Designated Party: CITY OF FORT COLLINS Designated Activity: ADDITIONAL INSURED/USE OF PASTURE LAND Designated Interests: GREENSHIRE STABLES LLC The Commercial Liability Coverage is amended as follows: DEFINITIONS I activities designated in the Schedule rating to: The definition of insured is amended to include the a. your operations; following: b. premises owned by or rented to you, or c. other designated interests shown in the Schedule. Insured also includes the party designated in the Schedule but only with respect to liability arising out of GL-841 Ed 1.0 Copyright MCMXCI, American Association of Insurance Services AAIS