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HomeMy WebLinkAbout106941 SYLVAN DALE GUEST RANCH - INSURANCE CERTIFICATE (2)DATE (MMIDD/YYYY) A� " CERTIFICATE OF LIABILITY INSURANCE F,2/20/2016 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 endorsements . PRODUCER CONTACT _ Arthur J. Gallagher Risk Management Services, Inc. NAME: PHONE 970-586-4407 F"X 970-586-3370 PO Box 4190 "�'�)' -- Estes Park CO 80517 E-MAIL INSURED Sylvan Dale Guest Ranch Susan Jessup 2939 N. County Road 31-D Loveland CO 80538 INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: Arch Insurance Company 11150 SYLVDAL-01 INSURER B: Pinnacol Assurance Company 41190 INSURER C : Essex Insurance Company _ 39020 I INSURER E : rnVFRAr.FS r.FRTIFICATF NIIMRFR• 1964010623 RFVI510N NUMRFR: 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 B POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD MID POLICY NUMBER MM/DDNY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MOPK07922605 9/1/2016 9/1/2017 EACH OCCURRENCE $1,000,000 CLAIMS -MADE XJ OCCUR rNTE PREMIISESEaoccurrence $100,000 MED EXP (An one person) $5,000 _ PERSONAL & ADV INJURY $1,000,000 GEN'L _ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY PRO JECT 7 LOC X PRODUCTS - COMPIOP AGG $3,000,000 $ OTHER: A AUTOMOBILE LIABILITY MOPK07922605 9/1/2016 9/1/2017 COMBINED M= LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) E ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) E HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY DAMAGE Per accident $ E UMBRELLA LIAB OCCUR EACH OCCURRENCE E AGGREGATE E EXCESS UAB CLAIMS -MADE DED RETENTION $ E B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Ya ANY PROPRIETOR/PARTNER/EXECUTIVE 2089342 10/1/2016 10/1/2017 Q H X STATUTE ER E.L. EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? 1(Mandatory in NH) N/A — E.L. DISEASE - EA EMPLOYEE $100,000 If yes, describe under -- E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below C Products Liability 3EF2232 6/1/2016 6/1/2017 Aggregate 2,000,000 Each Occurrence 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Agricultural and Dude Ranch Activities 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. CERTIFICATE HOLDER CANCELLATION 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 1 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD