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Home My WebLink AboutCO Berliner Haus LLC - Insurance Certificate MShelter Mutual Insurance Company 1817 W Broadway Columbia,MO 65218 1-800-SHELTER(743-5837) General Liability Insurance Policy Declarations Addl.Interest or Addl.Insured Copy Named Insured: Policy Number: 05-31-11493637-2 CO BERLINER HAUS LLC Effective Date: 05-01-2025(10:17 AM CST) 7373 W GRANT RANCH BLVD APT Expiration Date: 04-28-2026(12:01 AM CST) LITTLETON CO 80123-2663 Agent: JEFFREY MOSIER 05-D540-16 7800 S.ELATI ST SUITE 106 LITTLETON CO 80120 303-988-9600 Notice to the Additional Insured: Your interest will be continuous until cancellation notice is mailed to you. Policy and Endorsements are available upon request. Business of the Named Insured: FOOD TRUCK The Named Insured is a(n): Corporation Audit Period: Annual Limits of Insurance General Aggregate(Other Than Products- Completed Operations) - $2,000,000 - - -- Products-Completed Operations Aggregate Limit (See Each Classification Below) $2,000,000 Personal And Advertising Injury Limit $1,000,000 Each Occurrence Limit $1,000,000 Rented To You Limit $100,000 Any One Premises Medical Expense Limit $5,000 Any One Person Description of Hazards Premium Basis Rates Advance (Annual) Premium PREMISES&OPERATIONS- 16902 RESTAURANTS-WITH NO SALE OF ALCOHOLIC GROSS SALES PR$1000 2.558 $1,023.00 BEVERAGES-WITHOUT SEATING $400,000 ITEM ZIP CODE: 80123 7373 W GRANT RANCH BLVD APT LITTLETON CO PREMISES&OPERATIONS- 11039 CATERERS GROSS SALES PR$1000 1.260 $441.00 $350,000 ITEM ZIP CODE: 80123 7373 W GRANT RANCH BLVD APT LITTLETON CO PRODUCTS-COMPLETED OPERATIONS- 16902 RESTAURANTS-WITH NO SALE OF ALCOHOLIC GROSS SALES PR$1000 .144 $58.00 BEVERAGES-WITHOUT SEATING $400,000 ITEM ZIP CODE: 80123 7373 W GRANT RANCH BLVD APT LITTLETON CO Page 1 of 3 Policy Number: 05-31-11493637-2 Description of Hazards Premium Basis Rates Advance z_ (Annual) Premium PRODUCTS-COMPLETED OPERATIONS- 11039 CATERERS GROSS SALES PR$1000 .166 $58.00 $350,000 ITEM ZIP CODE: 80123 7373 W GRANT RANCH BLVD APT LITTLETON CO Premium Adjusting Endorsements Limits Deductible Number Premium Additional Insured-Owners,Lessees or Contractors- Scheduled CG 20 10 12 19 $158.00 Person or Organization THE CITY OF BOULDER Additional Insured-Owners,Lessees or Contractors-Scheduled CG 20 10 12 19 $158.00 Person or Organization CITY OF FORT COLLINS Additional Insured-Owners,Lessees or Contractors-Scheduled CG 20 10 12 19 $158.00 Person or Organization FT EVENTS LLC Total for Term(This is Not a Bill): $2,054.00 This policy has a fully-earned non-refundable minimum premium of$100.Q0 Policy forms and additional endorsements attached to this policy ¢ Number Commercial General Liability Coverage Form CG 00 0104 13 Products/completed Operations Hazard Redefined CG 24 07 0196 Asbestos Exclusion B-559-B Lead Poisoning Exclusion Endorsement B-601-B Non-Binding Arbitration CG 24 01 12 04 Employment-related Practices Exclusion CG 2147 12 07 Mutual Policy Notification S-1'8-S Amendatory Endorsement G-252.1-G Colorado Changes-Civil Union IL 0125 li 13 Exclusion-Unmanned Aircraft CG 2109 06 15 Amendment of Liquor Liability Exclusion CG 2150 04 13 Fungi Or Bacteria Exclusion CG 2167 12 04 Excl.Damage To Work By Subcontr On Your Behalf CG 22 94 10 01 Genetically Modified Organism Exclusion CG 40 01 12 19 Cross Suits Liability CG 40 10 12 19 Exclusion-All Hazards in Connection with an Electronic Smoking Device,its Vapor,Component CG 40 12 12 19, Parts,Equipment and Accessories Common Policy Conditions IL 00 17 1198 Nuclear Energy Liability Exclusion Endorsement(Broad Form) IL 00 2109 08 Colorado Changes-Cancellation and Nonrenewal IL 02 28 09 07 Silica or Silica-Related Dust Exclusion CG 2196 03 05 Communicable Disease Exclusion CG 2132 05 09 Cannabis Exclusion CG 40 14 12 20 Broad Abuse or Molestation Exclusion CG 40 28 09 22 Exclusion-Perfluoroalkyl And Polyfluoroalkyl Substances(PFAS) CG 40 32 05 23 Exclusion-Violation of Law Addressing Data Privacy CG 00 69 12 23 Exclusion-Electronic Data-Deletion of Bodily Injury Exception CG 21 85 12 23 Page 2 of 3 Policy Number: 05-31-11493637-2 Policy forms and additional endorsements attached to this policy Number Exclusion-Cyber Incident CG 40 35 12 23 -Addl Insured. Addl Insured CITY OF FORT COLLINS FT EVENTS LLC A d d I I n s u r e d THE CITY OF BOULDER (For Office Use Only) Transaction:PC SL 14.O.CODE:2,054.00 Policy ID:21008996712 Date Issued:05-01-2025 Policy Term:One Year '04282025' MPP Billing Frequency:Annually G-2.11-G _ .. . � . End of Declarations �� - m°�' �''�' •- -_ Page 3 of 3 This page intentionally left blank.