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Home My WebLink AboutJOHN ARNOLFO AND ARNESS SILVER - INSURANCE CERTIFICATEClient# 12645 SILGR ACORDTM CERTIFICATE OF LIABILITY INSURANCE 04/08/08°""" PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Ins Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P O Box 578 HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 4687 W 18th Street Greeley CO 80632 INSURERS AFFORDING COVERAGE NAIC # INSURED John Arnolfo & Arness Inc dba Silver 218 Walnut Street Fort Collins CO 80524 INSURER Travelers Insurance Company INSURERS Pinnacol Assurance INSURER C INSURER D INSURER E COVERAGES 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 LTR I SRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM 0 POLICY EXPIRATION / LIMITS A GENERAL LIABILITY 168056OD2031COF08 04/01/08 04/01/09 EACH OCCURRENCE $1000000 X CO dV1ERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300 000 CLAIMS MADE 5XI OCCUR MED EXP (Any one parson) $5 000 PERSONAL & ADV INJURY $1 00O 000 GENERAL AGGREGATE s2,000,000 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG s2,000,000 POLICY f PRO LOC A AUTOMOBILE LIABILITY ANY AUTO 1680560D2031COF08 04/01/08 04/01/09 COMBINED SINGLE LIMIT (Ea accident) $1 OOOOOO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON OWNED AUTOS X BODILYaccident) (Per accdent) t) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTOONLY EAACCIDENT $ OTHEEA ACC THAN $ ANY AUTO $ AUTO ON AUTO ONLY AGO A EXCESS/UMBRELLA LIABILITY X OCCUR 7 CLAIMS MADE ISFCUP630BY294INDO 04/01/08 04/01/09 EACH OCCURRENCE $1000000 AGGREGATE $1 000 000 $ DEDUCTIBLE X RETENTION $ 5000 $ B WORKERS COMPENSATION AND 4058092 07/01/07 07/01/08 X WC ORY IIMIT OTH S PH EMPLOYERS LIABILITY E L EACH ACCIDENT §SOD OOO �_ ANY PROPRIETOR/PARTNERIEXECU FIVE OFFICER/MEMBER EXCLUDED? If yes describe under E L DISEASE EA EMPLOYEE $500000 EL DISEASE POLICY LIMIT $500000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ** Supplemental Name ** John Arnolfo & Arness Inc dba Silver Grill John Arnolfo & Arness Inc City of Fort Collins 300 LaPorte Avenue Fort Collins CO 80521 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL IE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR AUTHORIZED REPRESENTATIVE R y- F-160- T' 04-4-11SO^J iAJf✓/'hut/GA r T/VL ACORD 25 (2001/08) 1 of 2 #S411471/M411469 PXC 0 ACORD CORPORATION 198E IMPORTANT If the certificate holder is an ADDITIONAL INSURED the policy(ies) must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) If SUBROGATION IS WAIVED subject to the terms and conditions of the policy certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s) authorized representative or producer and the certificate holder nor does it affirmatively or negatively amend extend or alter the coverage afforded by the policies listed thereon ACORD 25 5 (2001108) 2 of 2 #S411471/M411469