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Home My WebLink AboutTHE BURRITO DREAM - INSURANCE CERTIFICATEH t:NtVVAL UtH I IFI(;Al E -)0 SCOTTSDALE INSURANCE COMPANY Home Office: One Nationwide Plaza • Columbus, Ohio 43215 CLS1304328 Administrative Office: Policy Number 8877 North Gainey Center Drive • Scottsdale, Arizona 85258 1-800-423-7675 A STOCK COMPANY Item 1. Named Insured and Mailing Address: _ THE BURRITO DREAM, LTD "liii . C,iIVP.Th.GI IS M,UVEM-0 I'S A SURPLUS I_Wi MATTHEW BRITT L CHRIS LARSEN DBA: Lr1nrIR;.W1:H1J il-t"I�rt lM1IIEDW J ITN[I' 610 E LOCUST ST ll;, ,. 'MT 7;'_....,l,l-.f� Ilii M I,- Fort Collins, CO 80524 Agent Name and Address: COLONIAL GENERAL INSURANCE AGENCY P.O. BOX S71770 � Murray UT 84157 Agent No.: Program No.: 96 42:01 A.M. Standard Time at the address of the NAMED INSURED as stated herein. In consideration of the renewal premium stated, the above numbered policy is renewed for the period specified, subject to the terms and conditions thereof, except as otherwise specified herein. Agency Policy Fee 100.00 Premium Surplus Lines Tax 18.00 $ 500.00 Total 618.00 ® No changes from previous term. ❑ Changes on endorsement below are applicable with above inception date. Fees are Fully Earned No Flat Cancellations KRB 2/8/08 UTS-1 (12-00) INSURED utslf. fap Commercial Certificate of Insurance FARMERS' Agency Name F A R M E R S & Issue Date (MM/DD/YY) 03/18/2008 Address Jennifer Richardson Insurance Agency, hic. 333 W. Drake, Suite 131 This certificate is issued as a matter of infomntion only and confers no rights Fort Collins, CO 80526 upon the certificate holder. This certificate does not amend, extend or alter the 07 08 Agent 302 Dist. St. coverage afforded by the policies shown below. Companies Providing Coverage: Insured . The Burrito Dream, Ltd Company A Truck Insurance Exchange Letter Name . 610 E Locust St Company B Farmers Insurance Exchange & • Ft Collins, CO 80521 Letter Company C Mid -Century Insurance Company Address Letter Letterparry Scottsdale Insurance Company Coverages This is to certify that 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. Limits shown may have been reduced by paid claims. Co' Lu. Type of Insurance YP Policy Number Policy Effective Date (MM/DD/YY) Policy Expiration Date (MM/DD/YY) Policy Limits D K General Liability CLS1304328 01/30/2008 01/30/2009 General Aggregate $ 21000,000 K Commercial General Products-Comp/OPS Liability Aggregate $ 2,000,000 - Occurrence Version Personal & Advertising Injury $ 1,000,000 Contractual - Incidental Each Occurrence $ 1,000,000 Only Fire Damage (Any one fire) $ 100,000 Owners & Contractors Prot. Medical Expense (Any one person) $ 5,000 Automobile Liability Combined Single All Owned Commercial Limit $ Autos Bodily Injury (Per person Scheduled Autos $ Hired Autos Bodily Injury $ Non -Owned Autos (Per accident) Garage Liability I Property Damage $ Garage Aggregate $ Umbrella Liability Limit $ Workers' Compensation Statutory and Each Accident $ Employers' Liability Disease - Each Empbyee $ Disease - Policy Limit $ Description of Operations/Vehicles/Restrictions/Special items: Burrito Cart Certificate Holder is also listed as Additional Insured Certificate Holder Cancellation . City of Fort Collins Should any of the above described policies be cancelled before the expiration date Name . PO Box 580 thereof, the issuing company will endeavor to mail 30 days written notice to the & • Ft Collins, CO 80522 certificate holder named to the left, but failure to mail such notice shall impose no Address or liability of a y kind upon the company, its agents or repreentatves. ;ation zed Represen i e L9y 4-U4 Copy Distribution: mrvice`Center Copy and Agent's Copy Hot