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Home My WebLink AboutTHE SANDTRAP INC DBA MACKENZIE'S PUB & GRILL - INSURANCE CERTIFICATE�`� �® CERTIFICATE OF LIABILITY INSURANCE 12/28/2012 D2/28IDD012 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 Colorado BW Insurance Agency, Inc. 1075 W Horsetooth Rd, Ste 106 Fort Collins CO 80526 CONTACT NAME: mMatt Dieer PHONE (970)223-0924 AX No: (970)267-2231 -MAIL ADORES INSURERS AFFORDING COVERAGE NAIC k INSURERA:State Auto Insurance Companies INSURED The Sandtrap Inc. DBA: Mackenzie-s Pub & Grill 5750 S. Lemay Ave. Fort Collins CO 80525 INSURER B:Pinnacol Assurance 41190 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES rFRTIFir.ATF NIIMRFR-2013-2014 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 R ryPE OFINSURANLE ADDL UBR POLICY NUMBER MM/DDrYYYY MWDDNYVV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE -TO -RENTED PREMISES Ea cccunence $ 300, 000 MED EXP(Any one person) $ 5,000 A CLAIMS -MADE 1XI OCCUR BOP2722097 1/1/2013 1/1/2014 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 2,000,000 Liquor Liability $ 1,000,000 PRO LOC X POLICY F I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALLOWNEO SCHEDULED AUTOS UT NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION WC STATU- DTH- B AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE � OFFICEkIMEM 3ER EXCLUDED? (Mande ryIn NHl NIA 052833 /1/2012 2/1/2013 E.L. EACH ACCIDENT $ 100, 000 E. L. DISEASE - EA EMPLOYE $ 100,000 _'_DSEASE-P000Y IMI? $ 500 1 ono It yes dcdbe under D2SCRi�Tr0W Or OPERATION. Selrnr DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more apace is required) City of Fort Collins Golf Division PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Avery/MDFC 25 © 1988-2010 INSn25mmnnO) n, Th. Acnan rn,enno cnH Inns orn rnai.td r.H mark.. f arnan rights reserved.