HomeMy WebLinkAboutTAIPAN RESTAURANT - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE(MM1DD/YYYY)
TAIPA-1 05 13 08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
125 S Howes, 5th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P O Box 2226 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80522-2226
Phone: 970-482-7747 Fax:970-484-4165 i INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: The Phoenix Insurance Cc 25623
INSURERS Pinnacol Assurance
TaipaN.n Restaurant, Inc. IINSURERC 1
144 Mason St. Unit 8 ---
Fort Collins CO 60524 IINSURERD _
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.
INSR'AUD'U-""-"'-"--'-- POLIOY EFFECTIVE jPOLICV EXPIRATION -_.__...._ ......__....-.._ _._____ ..
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIODII'Y DATE MMIDDIYY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
I $ 1000000
X
I -
j COMMERCIAL GENERAL LIABILITY
( I680409D2458PHX08
DAMAGE TO RENTED _"-"
PREMISES (Ea occurence)
I ' -
$ 300000
J CLAIMS MADE I___ OCCUR
j
MED EXP(Any one person)
I $ 5000
A
X Business Owners
01/05/08
01/05/09
PERSONAL &AOV INJURY
�$1000000
GENERAL AGGREGATE
$ 2000000
PRODUCTS - COMP/OP AGG
{ $ 2000000
GEN'LAGGREGATE LIMIT APPLIES PER:
� PRO- '
POLICY JECT LOC
.__......_
....
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
lOOOOOO
A
ANY AUTO
I680409D2458PHX08
01/05/08
01/05/09
(Ea accident)
$
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULEDAUTOS
(Per person)
X
_. ...
HIRED AUTOS
j
BODILY INJURY
$
X
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
1
�
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY TO
—. _
OTHER THAN EA ACC
._- -
j11$
AUTO ONLY: AGO
!$
EXCIESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
Is
,_..1 OCCUR I CLAIMS MADE
AGGREGATE
i $
DEDUCTIBLE
$
RETENTION $
$
WORKERS COMPENSATION AND
TORV LIMITS I I EF$
B
EMPLOYERS'LIABILITY
4105442
06/01/08
06/01/09
tX -i
EL EACH ACCIDENT
$ 100000
ANY PROPRIETOPJPARTNER/EXECUTIVE
j
O EXCLUDED?
E.L.DISEASE EA EMPLOYE
$ 100000
yFFICER/MEMBER
DSPECIAL PROVISIONS below
E.L. DISEASE- POLICY LIMITI$
500000
OTHER
I
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Family Style Restaurant - Certificate Holder is included as Additional
Insured with repects to General Liability for an Outside Patio.
FAX 221-6378
CITYFT5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI,
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Purchasing IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
281 N College Avenue
Fort Collins CO 80522 REPRESENTATIVES.
1988