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HomeMy WebLinkAboutNORTHERN HOTEL FORT COLLINS - INSURANCE CERTIFICATEACORDTN EVIDENCE OF COMMERCIAL PROPERTY INSURANCE MD rYYY "1 612012 "' THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY. PRODUCER NAME, CONTACT PHONE 1-425-454-3366 COMPANY NAME AND ADDRESS NAIL NO: PERSON AND ADDRESS FAX 1-425-951-3716 WC. No: IInderaritera at Lloyd's London EMAIL ADDRESS: Allied World Assurance Company Arthur S. Gallagher Risk Management Services, Inc. Steadfast Insurance Company P.O. .Box 367 Ironshore Insurance, Ltd., at al Bellevue WA 98009-0367 MULTIPLE COMPANIES, COMPLETE SEPARATE FORM FOR EACH CODE: SUB CODE: AGENCY CUSTOMERIF NAMED INSURED ANDADDRESS LOAN NUMBER POLICY NUMBER Northern Hotel Port Collins, LP DBA: Northern Hotel N12NA041]0 National Development Council EFFECTIVE DATE EXPIRATION DATE 332 Michigan Avenue CONTINUED UNTIL Pueblo, CO 81004 06/30/12 05/30/13 TERMINATED IF CHECKED ADDITIONAL NAMED INSURED(S) THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION Use additional sheets if mores ace is required) LOCATION/DESCRIPTION Northern Hotel 172-North College Avenue Ft. Collins, CO 80525 Cf)VFRAC.F INFORMATION CAI ICF nP I r1SS PnPKA RGSIC RpnAn I X I Spprw nTHFR COMMERCIAL PROPERTY COVERAGEAMOUNT OF INSURANCE: $ 10,583,200 DED: 1,000 YES NO BUSINESS INCOME/RENTAL VALUE x If YES, LIMIT: 553, 150 X I Actual Loss Sustained #ofmonths: 12 BLANKET COVERAGE x If YES, indicate amount of insu rance on properties identified above: $50, 000, 000 TERRORISM COVERAGE x Attach signed Disclosure Notice / DEC IS COVERAGE PROVIDED FOR -CERTIFIED ACTS-ONLY7 If YES, SUBLIMIT: DED: IS COVERAGE A STAND ALONE POLICY? If YES, LIMIT: DED: DOES COVERAGE INCLUDE DOMESTIC TERRORISM? If YES, SUBLIMIT: DED: COVERAGE FOR MOLD If YES, LIMIT: DED: MOLD EXCLUSION (If "YES", specify organization's form used) REPLACEMENT COST x AGREED AMOUNT x COINSURANCE x If YES, % EQUIPMENT BREAKDOWN (IfApplicable) x If YES, LIMIT: 50,000,000 DED: 10,000 LAWANDORDINANCE -Coverage for loss to undamaged portion of building x If YES, LIMIT: 50,000,000 DED: 1,000 - Demolition Costs x If YES, LIMIT: 1,000,000 DED: - Incr. Cost of Construction x If YES, LIMIT: 1,000,000 DED: EARTHQUAKE (If Applicable) - — - x If YES, LIMIT. 10,000,000 DED: 100,000 FLOOD(ITApplicable) x If YES, LIMIT: 10,000,000 DED: 100,000 WIND/ HAIL (if Separate Policy) If YES, LIMIT: DED: PERMISSION TO WAIVE SUBROGATION PRIOR TO LOSS REMARKS - Including Special Conditions (Use additional sheets if more space is required) CANCELLATION THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 30 DAYS WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW, ADDITIONAL INTEREST NAME AND ADDRESS LENDER SERVICING AGENT NAME AND ADDRESS City of Fort Collins - P. O. Box 580 Fort Collins, CO 80522 USA MORTGAGEE ADDITIONAL INSURED AUTHORIZED REPRESENTATIVE LOSS PAYEE ACORD 28 (2003110) iomanion ©ACORD CORPORATION 2003 28212537 CERTIFICATE OF LIABILITY INSURANCE ATE D07/06 D/2012 07/O612 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 endorsement(s). PRODUCER 1-425-454-3386 Arthur J. Gallagher Risk Management Services, Inc. CONTACT NAME: JO¢Iln¢ Manion PHONE FAX .425-454-3386 C No: 425-451-3716 E41AIL ADDRESS: P.O. Box 367 INSURERS AFFORDING COVERAGE NAIL11 Bellevue, NA 98009-0367 INSURER A. Lexington Insurance Company INSURED Northern Hotel Port Collins, LP INSURER B : DBA: Northern Hotel INSURER C: INSURER D: National Development Council 332 Michigan Avenue Pueblo, CO 81004 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER- 28212591 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. INSIt LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSMADE rx] OCCUR 13135940 06/30/1 05/30/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISE E $ 50, 000 MEO EXP Any one Person $ Excluded PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PER: P" JECT X LOC PRODUCTS - COMP/OP AGO $2.000,000 E A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-0WNED HIRED AUTOS X AUTOS 13135940 0 1 05/30/13 COMBINED SINGLE LIMIT Ea..dent 11000,000 BODILY INJURY (Per Person) $ BODILY INJURY (Peramidenl) $ PROPERTY DAMAGE Per acddent $ E A X UMBRELLA LIAR EXCESS DAB X OCCUR CLAIMSMADE 13136436 06/30/1 05/30/13 1 EACH OCCURRENCE $25,000,000 AGGREGATE $ 25, 000, 000 DIED RETENTION$ 10, 000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORPARTNERIEXECUTIVE❑ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yyes, astoP eUnder DESORIPTION OF OPERATIONS bebx NIA WCSTATUj OTH- E.L. EACHACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more space Is required) V/11Y V CLL/111 V IY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Port Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P. 0. Box 580 AUTHORIZED REPRESENTATNE Port Collins, CO 80522 �- USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD jomanion 28212591