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HomeMy WebLinkAboutTOAST OF THE TOWN - INSURANCE CERTIFICATE (2)FOUNDERS INSURANCE COMPANY - A MULTIPLE LINE STOCK COMPANY 1645 EAST BIRCHWOOD AVENUE DES PLAINES, 1L 60018 (800)972-8778 / Fax (847) 795-0080 AGENCY ACCT CORRECTED AI CHARGE Liquor Liabili t y Amended Declaration EFFECTIVE 07/23 /09 LLC0000608 02/11/09 02/11/10 12: 01 AM STANDARD TIME 25 p5 NAMED INSURED AND ADDRESS PRODUCER TOAST OF THE TOWN, INC. GRANITE INSURANCE SERVICES, 523 N. WHITCOMB INC. FORT COLLINS CO 80521 3: W. 12SU AVE., SUITE 100 WESTMINSTER CO 80234 (720) 872-6406 COVERAGES THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS/POLICIES FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAy BE SUBJECT TO ADJUSTMENT. COVERAGE PART/POLICY ATTACHED PREMIUM FULLY EARNED COMPANY POLICY FEE_4_v ............ $75.00 MINIMUM AND DEPOSIT PREMIUM FORMS THAT APPLY TO APPLICABI,F. rnvRoarn uivl ivv l;lJ t'1'l UN DATE DESCRIPTION CG 21 87 01-07 Conditional Exclusion of Terrorism CO-CSL 12-07 Colorado Liquor Liability Coverage Part DDITIONAL INSUREDS) I# INTEREST NAME AND ADDRESS 1 INTEREST CITY OF FORT COLLINS PURCHASE AND RISK MANAGEMENT P.O. BOX 580 FORT COLLINS CO 80522 CNANCE COMPANIES 1 NAME AND ADDRESS PREMIUM FINANCING SPECIALISTS ACC# COD-181012 P O BOX 260699 LAKEWOOD CO 80226-0699 COVERAGE PARTS/POLICIES ATTACHED, jWEjAGREE�'A\Ild ALL WITHUYOUCTOTPROVIDEHT TERMS TH DESCRIBED THEREIN. HE INSURRAA NCE Special Interest WWW.FOUNDERSINSURANrF rnm DATR. n4/nain FOUNDERS INSURANCE COMPANY - A MULTIPLE LINE STOCK COMPANY .,..- 1645 EAST BIRCHWOOD AVENUE DES PLAINES, IL 60018 (800) 972-8778 / Fax (847) 795-0080 Liquor Liability Amended Declaration AGENCY ACCT ADD ADDITIONAL INSURED EFFECTIVE 07/23/09 POLICY NUMBER FROM POLICY PERIOD TO LLC0000608 1 02/11/09 02/11/10 12:01 AM STANDARD TIME 2505 NAMED INSURED AND ADDRESS PRODUCER TOAST OF THE TOWN, INC. GRANITE INSURANCE SERVICES, 523 N. WHITCOMB INC. FORT COLLINS CO 80521 1020 W. 124TH AVE., SUITE 100 WESTMINSTER CO 80234 (720) 872-6406 :.. ::.ax#.,:........4, COVERAGES THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS/POLICIES FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. COVERAGE PART/POLICY ATTACHED PREMIUM COMMERCIAL LIQUOR LIABILITY COVERAGE ....................... $909.00 FULLY EARNED COMPANY POLICY FEE ........................ $75.00 MINIMUM AND DEPOSIT PREMIUM ................................ $984.00 THE CHANGE IN THIS POLICY HAS RESULTED IN AN ADDITIONAL PREMIUM OF ................ $56.00 FORMS THAT APPLY TO APPLICABLE COVERAGE PARTS ENDORSEMENT NO EDITION DATE DESCRIPTION CG 21 87 01-07 Conditional Exclusion of Terrorism CO-CSL 12-07 Colorado Liquor Liability Coverage Part ADDITIONAL INSURED(S) AI# INTEREST NAME AND ADDRESS 1 INTEREST CITY OF FORT COLLINS PURCHASE AND RISK MANAGEMENT P.O. BOX 580 FORT COLLINS CO 80522 FINANCE COMPANIES FC# NAME AND ADDRESS 1 PREMIUM FINANCING SPECIALISTS ACC# COD-181012 P O BOX 260699 LAKEWOOD CO 80226-0699 Special Interest