HomeMy WebLinkAboutTHE BURRITO DREAM - INSURANCE CERTIFICATE (3)I, ENDORSEMENT
SCOTTSDALE INSURANCE COMPANYO. NO. of
ATTACHED TO AND
ENDORSEMENT EFFECTIVE DATE
NAMED INSURED
AGENT NO.
FORMING A PART OF
(12:01 A.M. STANDARD TIME)
POLICY NUMBER
CLS1S72260
01/30/2009
THE BURRITO DREAM, LTD
43006
IN CONSIDERATION OF THE PREMIUM CHARGED, IT IS HEREBY UNDERSTOOD
AND AGREED THAT THE FOLLOWING ADDITIONAL INSURED IS ADDED TO .
THIS POLICY PER ATTACHED FORM CG2010.7-96:
CITY OF FORT COLLINS
P.O. BOX S80
FORT COLLINS, CO 80S22
ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME
a
`THIS CONTRACT IS DELIVERED AS A SURPLUS LINE
COVERAGE UNDER THE "NONADMITTED INSURANCE ACT
THE INSURER ISSUING THIS CONTRACT IS NOT LICENSED IN
COLORADO BUT IS AN APPROVED NONADMITTED INSURER
THERE IS NO PROTECTION UNDER THE PROVISIONS OF THE
COLORADO INSURANCE GUARANTY ASSOCIATION ACT'
N
AUTHORIZED REPRESENTATIVE
UTS-39 (3-92) AGENT
02/23/2009 KRB
DATE
POLICY NUMBER: CLS1572260
COMMERCIAL GENERAL LIABILITY
CG 20 12 07 98
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -
STATE OR POLITICAL SUBDIVISIONS - PERMITS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
State Or Political Subdivision:
CITY OF FORT COLLINS
P.O. BOX 580
FORT COLLINS, CO 80522
(If no entry appears above, information required to complete this endorsement will be shown in the ueciarations as
applicable to this endorsement.)
Section II - Who Is An Insured is amended to
include as an insured any state or political subdivision
shown in the Schedule, subject to the following
provisions:
1. This insurance applies only with respect to oper-
ations performed by you or on your behalf for
which the state or political subdivision has issued a
permit.
2. This insurance does not apply to:
a. "Bodily injury," "property damage" or "personal
and advertising injury" arising out of operations
performed for the state or municipality; or
b. 'Bodily injury" or "property damage" included
within .the "products -completed operations
hazard".
CG 20 12 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1
AGENT