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125071 ROCKY MOUNTAIN RECREATION NC - INSURANCE CERTIFICATE
ROCKMOU-09 PWEEKS ACORO"' CERTIFICATE OF LIABILITY INSURANCE �..�� FDAATE(MM/DD/YYYY) 08/22/2018 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 COINTACT Paula Weeks HONE FA. EXt : (303) 762-1717 A/c, No :(303) 762-1733 Forsberg Engerman Co 3575 S Sherman St Englewood, CO 80113 E-MAIL , paula@forsberg-engerman.com INSURERS AFFORDING COVERAGE NAIC # INSURER A : Cincinnati Specialty Underwriters Insurance Company 13037 INSURED INSURER B:The Cincinnati Indemnity Company 23280 INSURER C : Scottsdale Insurance Company 41297 Rocky Mountain Recreation Inc INSURER D : Pinnacol Assurance 41190 PO Box 620411 Littleton, CO 80162 INSURER E INSURER F COVFRAnFR CERTIFICATE NUMRFR- 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 EXPLTIR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F7X OCCUR CS00040682 08/10/2018 08/10/2019 DAMAGE TO R_ES �EaENTED occurrence) 100,000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY 7 PRO- LOC $ OTHER: B AUTOMOBILE LIABILITYdent) COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) X ANY AUTO EBA 0178279 08/10/2018 08/10/2019 BODILYBODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE er accident Per. X AUTOS ONLY X A�TOS ONLDY $ C X UMBRELLA LAB X OCCUR EACH OCCURRENCE 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE CXS0007955 08/10/2018 08/10/2019 DED I I RETENTION $ $ D WORKERS COMPENSATION X PERTUT; OTH- AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PlEXECUTIVE OFFICER/MEMBER EXXCLUDECLUDED? Y I (Mandatory in NH) N I A 4189358 08/01/2018 08/01/2019 E.L. EACH ACCIDENT 1,000,000 $ F I- DISEASE - FA EMPLOYEE A 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below B Equipment Floater EBA 0178279 08/10/2018 08/10/2019 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. K 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. A�UTHO�RIZEDD REPRESENTATIVE 1jl ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD