HomeMy WebLinkAboutNEWFLOWER MARKET SUNFLOWER MARKET - INSURANCE CERTIFICATEThis certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies, BMW 68
Certificate of Insurance
This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend or alter the coverage
afforded by the policies listed below.
This is to certify that (Name and address of Insured)
NEWFLOWER MARKETS INC DBA
SUNFLOWER MARKETS
6105 MONARCH RD
LONGMONT, CO 80503-8818
is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to
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all their terns, exclusions and conditions and
Expiration Tvpe
Expiration Dates
Policy Numbers
---------- ---
Limits of
Lut ili
Continuous*
08/01/2006
WC5-191-434990-015
Coverage afforded under WC law of
Employers Liability
Extended
the following states:
Bodily Injury By Accident
X
Az, CO, NM, NV
Policy Term
$500,000 Each Accident
Bodily Injury By Disease
$500,000 Policy Limit
Workers Compensation
Bodily Injury By Disease
$500,000 Each Person
General Liability
General Aggregate -Other than Prod/Completed Operations
Products/Completed Operations Aggregate
Claims Made
Occurrence
Bodily Injury and Property Damage Liability
Per
Occurrence
Retro Date
Personal and Advertising Injury
Per Person /
Organization
Other Liability
Other Liability
Each Accident - Single Limit - B. I. and P. D. Combined
Automobile Liability
Owned
Each Person
Non -Owned
Each Accident or Occurrence
Hired
Each Accident or Occurrence
C
O
M
M
E
N
T
S
*If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However, you will not be notified annually of
the continuation of coverage.
Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or
deceptive statement is guilty of insurance fraud.
Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for any reason, please contact your local sales producer,
whose name and telephone number appears in the lower left comer of this certificate. The appropriate local sales office mailing address may also he obtained by calling this number. '
Notice of cancellation: (not applicable unless a number of days is entered below) . Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above
policies until at least 30 days notice of such cancellation has been mailed to:
Office: ENGLEWOOD,CO Phone: 303-799-0818
Certificate Holder:
CITY OF FT COLLINS
PO BOX 580
FT COLLINS, CO 80522-0580
MARILYN ANDERSON
Authorized Re resentative
Date Issued: 08/08/2005 Prepared By: PK