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HomeMy WebLinkAbout125071 ROCKY MOUNTAIN RECREATION INC - INSURANCE CERTIFICATE (6)PWEEKS
ROCKMOU-09
ACORO" CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
10/03/2017
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 Paula Weeks
Forsberg Engerman Co
3575 S Sherman St
Englewood, CO 80113
HO Ne, Ext : (303) 762-1717 FAAic, No :(303) 762-1733
E-MA'L . paula@forsberg-engerman.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Cincinnati Specialty Underwriters Insurance Company
13037
INSURED
INSURER 8:The Cincinnati Indemnity Company
23280
INSURER C : Pinnacol Assurance
41190
Rocky Mountain Recreation Inc
INSURER D :
PO Box 620411
Littleton, CO 80162
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 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
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1 ,000,000
CLAIMS -MADE a OCCUR
CS00040682
08/10/2017
08/10/2018
DAMAGE TO R(EaENTED crurrence)$
ISESMED
100,000
EXP (Any oneperson)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
POLICY F-x I jEReT LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER
B
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
1,000,000
X
BODILY INJURY Perperson)
$
ANY AUTO
EBA 0178279
08/10/2017
08/10/2018
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY Per accident
$
X
PROPERTY DAMAGE
Per accident
$
HIRED X NON -AWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
C
WORKERS COMPENSATION
X PER OTH-
STATUTE
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N/A
4189358
08/01/2017
08/01/2018
E.L. EACH ACCIDENT
1,000,000
$
E.L.. DISEASE - EA EMPLOYEE
1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
_$
1,000,000
$
B
Stored Materials
EBA 0178279
08/10/2017
08/10/2018
300,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate holder is Additional Insured as respects Auto Liability and General Liability. The insurance evidenced by this Certificate will not be cancelled or
materially altered, except after ten (10) days written notice has been received by the City of Fort Collins.
City of Fort Collins
P.O. 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
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD