HomeMy WebLinkAboutTHE COFFEE STOP - INSURANCE CERTIFICATE09/17/2003 14:57 9703779517 FARMERS INSURANCE PAGE 02/02
ACORD CERTIFICATE OF LIABILITY INSURANCE 09/(17/� 03
IDOUDER
Jason E. Welch Insurance Agency
2627 Redwing Road #260
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CAMFFRS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins, CO 80526
970-377-9420
INSURERS AFFORDING COVERAGE
NAIC}T
MURED __ I'he Cof>:ee Stop
INSURER A: `Farmers Insurance Exch.
INSURERS; FarmeC'S^Indurancc EXCh.
INSURER c:
_, .
1017 South Lemay
Ft. rnllin4, CO 80524
_
INSURER D;
wvelcA�ea
THE POLICIES OF INSURANCt LIS I tU NtLOW HAVE BEEN 153UED TD THE IN3UR[.D NAMCDABOvE FOR THE PQLICV PERIOD wnInAYFD. 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.
GENERAL LIABILITY
Y' I QQMMERGAL GENERAL LIABILITY
CLAIMSMADE I——] OCCUR
A X —_ _ . _I045989862
GEN'L AGGREGATE LIMIT APPLIES PER',
AUTOMOBILE LIABILITY
_ ANYAUTO
ALLUVVNt0AUTO5i
_ SCHEDULED AUTOS
HIRED AUTOS
NON OWNEDAUTOS
IdE LwEILm
ANYAUTO
BSAIMERELLA UABIUTY
OCCUR CI CLAIMSMADE
DEDUCTIBLE
EACH OCCURRENCE ; - v v , v vv w
PRFMIEEE„
MEOEXPIAny�p=w) _ E
09/17/03 09/25/04 PERSONAL&ADVINJURY S 50 , 000
GeHFRAL AGGRcvnx - It1, 000, ouu—
FRDDUCTS.COMPIDPAGG s , OOO�a
COMBINED SINGLE LIMIT
(Ee RcadardI
00011.YINJURY
(Per pr _w)
BODILY INJURY
fPAfncrelnnl}
PROPERTY DAMAGE
(Peeaccidenq
AUTO ONLY -EA ACCIDEI
OTHERTHAN ..�.
AUTOONLY:
EACH OCCURRENCE _
AGGREGATE
WORKERSCOMPENSAnoNAW _LVE j,MRS .I_.
EMPLOYER&' LIABILITY A 0 4 0 9 3115 0 9/ 0 8/ 0 3 0 9/ 0 6/ 0 4 E.L. EACH ACCIDENT
e'rf Mn 11kTORPMIIIENEzrr.10 E
WncrR mwh. ewi.uw,,, F I.. DISEASE - EA EA
Ives, dwri.h under
SPECIAL PROVISIONS UAIOW E.L DISEASE - POLIC
OTHER
DESCRIPTMN OF OPERATIONS ILOCATION$ r VEHICLES I E)(CLUSIONSADDEO BY ENDORSEMENT/ SPOCIAL PROVISIONS
Certificate Holder named as Additional Insured
City of Fort. C'n1lins
PO ,Box 580
Ft. Collins, CO 80522
-- 100, ao0
5U .000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORF. THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO NAIL 15 OAYS WRITTEN
NOTICE TO THE CFRTIACATE HOLDER NAMPO TO THE LEFT, BITT FAILURE TO 00 SD SHALL
IMPOSE NO OBLIGATION OR LIABNTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR