HomeMy WebLinkAboutQUINN MCELWEE - INSURANCE CERTIFICATEA �® CERTIFICATE OF LIABILITY INSURANCE
IkI
DATE DD019
7/1s/zo19
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
Leavitt Recreation 6 Hospitality Insurance, Inc.
942 14th Street
Sturgis SD 57785
CONTACT NAME: Nick zzSpencer
PHOAIC,NE (800)525-2060 FAX No): I866l465-2797
E-MAIL ADDRESS: nick-spencer@leavitt.com
INSURERS AFFORDING COVERAGE
NAIC e
INSURERA: Great American Insurance Group
INSURED
Quinn McElwee
10555 CR 13
Wellington CO 80549
INSURER B :
INSURER C:
INSURER D:
INSURER E :
INSURER F:
CnVFRAnFA CERTIFICATE NUMBER:19/20 cox 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
LTR
TYPE OF INSURANCE
A 'DL
SUBR
POLICY NUMBER
POLICY EFF
MMIDD/YYVY
POLICY EXP
MM)D )YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
E 1,000,000
A
CLAIMS -MADE 7X OCCUR
DAMAGE RENTED
PREMISES E.00.m.no.
E 100,000
MED EXP(Any one person)
E 10,000
X
AFL E407702
7/11/2019
7/11/2020
PERSONAL SADV INJURY
S 11000,000
GEN'LAGGREGATE LIMITAPPLIES PER:
GENERALAGGREGATE
E 2,000,000
PRODUCTS - COMP)OPAGG
E 2,000,000
%t POLICY ❑ PRO- ❑ LOC
JECT
Chemical Drift Aggregate
E 25,000
OTHER'.
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ee accident
E
BODILY INJURY (Pm person)
S
ANYAUTO
BODILY INJURY (Per accident)
S
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIREDAUTOS AUTOS
PROPERTY DAMAGE
Per accident
S
UMBRELLALIAB
OCCUR
EACH OCCURRENCE
E
AGGREGATE
E
EXCESS LIAR
CLAIMS -MADE
DED I I RETENTION E
E
WORKERS COMPENSATION
PMF H
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR)PARTNER/EXECUTNE
E.L EACH ACCIDENT
E
EJ_ DISEASE - EA EMPLOYEE
E
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
N I A
EL. DISEASE- POLICY LIMIT
1 E
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached It more space Is required)
Location Description - Bobcat Ridge Natural Area, 570 Acres, Loveland, CO, 80538; East Half Coyote Ridge
Natural Area, 200, Fort Collins, CO, 80526; 10555 N CR 13, Wellingon, CO, 80549
IT IS UNDERSTOOD AND AGREED THAT THE CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED, BUT ONLY WITH
RESPECT TO ITS LIABILITY ARISING OUT OF THE ACTIVITIES OF THE NAMED INSURED.
k,cm I Iril Al c r1VLVCR
City of Fort Collins CO
City's Purchasing Director
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
Petty/JOAGA �� =
ACORD CORPORATION.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS026 (201401)