HomeMy WebLinkAboutPIZZA CAZBAH - INSURANCE CERTIFICATE (2)CERTIFICATE OF INSURANCE
This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
❑ STATE FARM GENERAL. INSURANCE COMPANY, Bloomington, Illinois
❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
❑ STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
❑ STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated below:
Policyholder ZA.HAKTS iNC (d:ba Pizza Casbah)
Address of policyholder
Location of operations
Description of operations
126 W Laurel Fort Collins CO
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
Effective Date Expiration Date
LIMITS OF LIABILITY
(at beginning of policy period)
96-GS-9299-9 F
Comprehensive 04/15/2008 04/15/2009
BODILY INJURY AND
Business Liability
PROPERTY DAMAGE
This insurance includes:
® Products - Completed Operations
❑ Contractual Liability
❑ Underground Hazard Coverage
Each Occurrence $ , , 000, 000
❑ Personal Injury
❑ Advertising Injury
General Aggregate $ 2, 000,000
❑ Explosion Hazard Coverage
❑ Collapse Hazard Coverage
Products - Completed $ 2,000,000
❑
Operations Aggregate
❑
EXCESS LIABILITY
POLICY PERIOD
Effective Date Date
BODILY INJURY AND PROPERTY DAMAGE
(Combined Single Limit)
❑ Umbrella
Each Occurrence $
_Expiration
_
❑Other
Aggregate $
Part 1 STATUTORY
Part 2 BODILY INJURY
Workers' Compensation
and Employers Liability
Each Accident $
Disease - Each Employee $
Disease - Policy Limit $
POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
Effective Date ; Expiration Date
LIMITS OF LIABILITY
(at beginning of policy period)
THE CERTIFICATE OF INSURANCE 13 NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
Re: City of Fort Collins is named as additional insured as If any of the described policies are canceled before
their interests may appear its expiration date, State Farm will try to mail a written
notice to the certificate holder 10 days before
cancellation. If however, we fail to mail such notice,
Name and Address of Certificate Holder no obligation or liability will be imposed on State
Farm or its agents or representatives.
City o` Fora; Collins Purchasing Division �--�
P.0 lox 58C
Fort Collins, CO 80522 - Sg- i na[ur I`Au�epr6"—eritakiar------ _
Agent 05/23/2008
Title Date
Agent's Code Stamp
S. YOUNtE 06 =7
AFO Code f 62FIRE 86
Rocky Mountain AFO F913
555-994 a.4 11-12-2002 Printed to U.S.A.