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HomeMy WebLinkAbout106941 SYLVAN DALE RANCH - INSURANCE CERTIFICATEAC 8 79/6/2018 E(MM/DD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: _ _----- Arthur J. Gallagher Risk Management Services, Inc. PHONE ExtZ970-586 4407 FAX No):970-586-3370 PO Box 4190 --- - Estes Park CO 80517 ADDRESS; INSURED Sylvan Dale Guest Ranch Susan Jessup 2939 N. County Road 31-D Loveland CO 80538 INSURERS) AFFORDING A; Pinnacol Assurance Comp a: Arch Insurance ComDanv D: COVERAGES CERTIFICATE NUMBER: 1116695074 REVISION NUMBER: 41190 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, INTSRR TYPE OF INSURANCE DDL SUBR POLICY NUMBER MM/D YYYY) I (MM/bDIYYYYI LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rX_ OCCUR MOPK07922607 9/112018 9/1/2019 EACH OCCURRENCE $1,000,000 PREMISES Ea occurrence $100,000 MED EXP (An one person) $ 5,000 $1,000,000 PERSONAL & ADV INJURY GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑ JECT LOC OTHER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 3,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY MOPK07922W7 9/1/2018 9/1/2019 COMBINED SINGLE LIMIT Ea accident) $1,000,000 _ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y❑N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If Yes, describe under DESCRIPTION OF OPERATIONS below N/A 2089342 10/1/2017 10/1/2018 X STATUTE ERH --- $ 100,000 E.L. EACH ACCIDENT E.L. DISEASE • EA EMPLOYE - — $100,000 E.L. DISEASE - POLICY LIMIT --- $ 5W,000 � II I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) The City, its officers, agents and employees shall be named as additional insured but only with respects to the liability arising out of the activities of the named insured per form 00 GL0596 00 04 10 - BLANKET ADDITIONAL INSURED. I"111N1111 i City of Fort Collins Purchasing Department PO Box 580 Ft 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 0)1988-2015 ACORD CORPORATION. All riahts reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD