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HomeMy WebLinkAboutRAM INTERNATIONAL 1 LLC - INSURANCE CERTIFICATE (4)A� o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/25/2015 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 endorsements . PRODUCER Arthur J. Gallagher Risk Management Services, Inc. P.O. Box 2925 Tacoma WA 98401-2925 CONTACT NAME: JoyLewis PHONE 206-607-0954 FAx 253-572-1430 E-MAIL o I @ jg. . j y_ ewis a com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Contlnental Western Insurance Coma 10804 INSURED INSURERB:ArCh Insurance Company 11150 Ram International 1 LLC Attention: Tim Bunch INSURERC: PO Box 98768 INSURER D : INSURER E : Lakewood WA 98496 INSURER F : COVERAGES CERTIFICATE NUMBER: 361816704 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES ; )F INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRAST 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDY EFF MM/ DY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR CWP297241024 /1/2015 /1/2016 EACH OCCURRENCE $1,000,000 DAMAGES( RENTED PREMISES Ea occurrence) $100,000 X MED EXP (Any one person) $10,000 $5,000 PD Ded. PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY JECT FX] LOC F1 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY CWP297241024 /1/2015 /1/2016 OMB' EDt SINGLE $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ HIRED AUTOS X NON -OWNED AUTOS X ROPERTY DAMAGE Zero Per accident $ $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB r—rDED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? OFFICE(Mandatory N / P` ZAWC16503800 /1/2015 7/1/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 in NH) (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below A Liquor Liability Employers Liab - Stop Gap CWP297241024 (WC Stop Gap) /1/2015 /1/2016 Each common cause 1,000,000 Aggregate 2,000,000 Per Occ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Collindale Golf Course - Restaurant/Snack Bar/Concession Agreement Named Insured includes: Collindale 57 LLC d/b/a CB & Potts VCRI Iri%,mIa nVLUrM GANGtLLAI IUN OV UdYS INV%- The City of Fort Collins, Colorado 300 LaPorte Avenue Fort Collins CO 80521 USA 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 004770 A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6l25l2015 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 endorsements . PRODUCER Arthur J. Gallagher Risk Management Services, Inc. P.O. Box 2925 Tacoma WA 98401-2925 CONTACT NAME: Joy Lewis oy Lew?-0954 PHONE . F""f NI : 253-572-1430 EAI -ML .joy_lewis@ajg.com INSURERS AFFORDING COVERAGE NAIC # INSURER A :Arch Insurance Company 11150 INSURED INSURER B : INSURER C : Ram International 1 LLC Attention: Tim Bunch PO Box 98768 INSURER D INSURER E : Lakewood WA 98496 INSURER F : COVERAGES CERTIFICATE NUMBER: 1121390463 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 3ELOW 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 PFRTAIN, 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 INSD WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT ❑ LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMI 1 Ea accident)$ BODILY INJURY (Per person) $ tid P BODILY INJURY (Per accident) ( ) $ PROPER DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINX ANY PROPRIETOR/PARTNER/EXECUTIVE —] OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A ZAWCI6503800 /1/2015 7/1/2016 PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Collindale Golf Course - Restaurant/Snack Bar/Concession Agreement Named Insured includes: Collindale 57 LLC d/b/a CB & Potts l;tK 1 It-IGA It HULUtK The City of Fort Collins, Colorado 300 LaPorte Avenue Fort Collins CO 80521 USA 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 003715