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HomeMy WebLinkAboutCONEJO AZUL - INSURANCE CERTIFICATE4/12/2007 10:37 AM FROM: Fax TO: 221-6707 PAGE: 001 JF 001 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DTE A03/28107rvY) PRODUCER Welsh Insurance Agency, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 4033 Boardwalk Drive, Suite #200 Fort Collins, CO 80525 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # Phone (970)206-1810 Fax (970)206-1808 INSURED Conejo Azu, Inc. 410 S. Grant Ave. Fort Collins, CO 805212539 INSURER A: AUTO -OWNERS INSURANCE CO INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADO'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/Y1' POLICY EXPIRATION DATE MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE 500,000 © COMMERCIAL GENERAL LIABILITY 74926439 08/28/06 08/25/07 TO RETED PREMISES Ea occurence 300.000 A 0 ❑❑ CLAIMS MADE W OCCUR ❑ MED EXP (Any one person) 10,000 PERSONAL 8ADVINJURY 500,0()0 ❑ GENERAL AGGREGATE 1,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG 1,000,000 © POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO COMBINED SINGLE LIMIT (Ea accident) ❑ ❑ ALL OWNED AUTOS ❑ SCHEDULEDAUTOS ❑ HIREDAUTOS ❑ NON OWNED AUTOS i BODILY INJURY � (Per person) BODILY INJURY (Per accident) ❑ PROPERTYDAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY- EA ACCIDENT ❑ ❑ ANY AUTO ❑ OTHER THAN EAACC AUTO ONLY: AGG EXCESS LIABILITY EACH OCCURRENCE ❑ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION WORKERS COMPENSATION AND EMPLOYERS'LUIBILITY ❑ WC STATU- ❑ OTH- TORY LIMITS OR E.L. EACH ACCIDENT ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? E.L. DISEASE- EA EMPLOYEE Ifyes, describe under E.L. DISEASE- POLICY LIMIT SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS HOT DOG STAND l CITY OF FORT COLLLINS IS LISTED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Fort Collins - PURCHASING DEPARTMENT 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO Attn: Purchasing PO BOX 580 THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 (s) ACORD CORPORATION 1988