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Home My WebLink AboutTOAST OF THE TOWN - INSURANCE CERTIFICATE (3)CL2256335 United States Liability Insurance Group COMMERCIAL Renewal of Number 190 South Warner Road Wayne, PA 19087 IA ILITY POLICY DECLARATIONS ❑✓ United States Liability Insurance Company POLICY ❑ Mount Vernon Fire Insurance Company ORIGINAL CL1148374 ❑ U.S. Underwriters Insurance Company (q Named Insured TOAST OF THE TOWN, INC.��n V� Address 523 N. WHITCOMB FT. COLLINS, CO 80521 Policy Period Froml02/11/2005 To 02/11/2006 12:01 AM STANDARD TIME AT YOUR Form Of Business Corporation MAILING ADDRESS SHOWN ABOVE Business Description Concessionaire THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A LIMIT OF INSURANCE IS INDICATED. Coverage Part Limits Of Insurance Premium Each Occurrence Limit Not Covered Personal & Advertising Injury Limit (Any One Person/Organization) Not Covered Medical Expense Limit (Any One Person) Not Covered Damage To Premises Rented To You (Any One Premises) Not Covered Products/Completed Operations Aggregate Limit Not Covered General Aggregate Limit (Other Than Products/Completed Operations) Not Covered Each Common Cause Limit $300,000 Aggregate Limit $300,000 Each Claim/Medical Incident Limit Not Covered Aggregate Limit Not Covered Total Advance Premium For This Policy (This Premium may be subject to adjustment.) Location Of All Premises You Own, Rent, Or Occupy: 1) 417 W. Magnolia, Ft. Collins, CO 80521 PREMIUM COMPUTATION Location Classification Code No. Premium Basis Rate Advance Premium Territory Pr/Co All Other Pr/Co All Other 1 Concessionaire at Lincoln Event Center 00034 R) 87000 N/A 0.878 N/A $1,054 002 rated as miscellaneous liquor MD covera a Form(s)/Part(s) and Endorsement(s) made a part of this policy at time of issue: See Endorsement EOD (01 /95) 1 Policy Premium $1,054.00 Policy Fee $150.00 Total $1,204.00 Agent GRANITE INSURANCE SERVICES, INC. Issued Date: 02/11/2005 By'774 Authorized Representati, CLD (4/2000) ACORDCERTIFICATE OF LIABILITY INSURANCE 7:7t7ODA (MMIDDIYYYY) 29/2004 PRODUCER (970) 484-2805 John C. Beckett & Associates, Inc. 220 Smith Street Ft. Collins CO 80524- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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# INSURED Toast Of The Town, Inc. 523 N. Whitcomb Fort Collins CO 80521- INSURER A: Penn -America INSURERB:United States Liability INSURER C: INSURER D: INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE DATE(MMIDDIYY) POLICY EXPIRATION DATE(MMIDDIYY) LIMITS a GENERAL LIABILITY x COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑X OCCUR YAC6284961 / / 02 /11/2004 / / 02 /11/2005 EACH OCCURRENCE $ 500,000 DAMAGE TO REN PREMISES Ea occurrence TED $ 100,000MED EXP (Any oneperson) $ 5,000 PERSONAL B ADV INJURY S 500,000 GENERAL AGGREGATE $ 500,000 GENT AGGREGATE LIMIT APPLIES PER: 17 POLICY JE LOC PRODUCTS - COMPIOP AGG $ 500,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS NO COVERAGE / / / / / / / / / / / / COMBINED SINGLE LIMIT (Es accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO 1 NO COVERAGE / / / / AUTO ONLY - EA ACCIDENT $ OTHER THAN FA ACC AUTO ONLY: AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ NO COVERAGE / / / / / / / / EACH OCCURRENCE $ AGGREGATE $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? If r yes, describe uncle SPECIAL PROVISIONS below NO COVERAGE / / / / / / / / WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ B OTHER Liquor Liability CL2256335 02/11/2004 02/11/2005 300000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS ATTN: Sherry The Lincoln Center 417 W. Magnolia St. Fort Collins (970) 221-6373 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE AUTHORIZED REPRESENTATIVE L �j C ACORD CORPORATION 1988 PLC INS025 (oiw).m ELECTRONIC LASER FORMS, INC.-(800)327-0545 Page 1 of 2