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Home My WebLink About478664 PROFESSOR MUNCHIE CONCESSIONS (G BJORKLUND) - INSURANCE CERTIFICATECOMMON POLICY DECLARATIONS New Business Declarations POLICY NO. 1CT0637621/CO-0100001/A01 NATIONAL FARMERS UNION PROPERTY AND CASUALTY COMPANY 5619 DTC PARKWAY - SUITE 300 GREENWOOD VILLAGE, COLORADO 80111-3136 NAMED INSURED: GARRY BJORKLUND DBA PROFESSOR MUNCHIE MAILING ADDRESS: 5200 STILLWATER CREEK CT FORT COLLINS CO 80528-8514 JOHN C NOLAND C0000210 DBA NOLAND INDUSTRIES 121 E SWALLOW RD # 115 FORT COLLINS CO 80525-2568 POLICY PERIOD: From 2/22/10 to 2/22/11 at 12:01 A.M. Standard Time at your mailing address shown above. BUSINESS DESCRIPTION: RESTAURANT IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF. THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial Property Coverage Part $ 75 Commercial General Liability Coverage Part $ 1,364 Commercial Crime Coverage Part $ 0 Commercial Inland Marine Coverage Part $ 0 Commercial Auto Coverage Part $ 0 TOTAL- $ 1,439 Forms applicable to all Coverage Parts: IL0017 (11-98) IL0021 (07-02) IL0228 (07-02) IL0169 (07-02) IL0935 (07-02) CF150 (11-85) CL150 (11-85) COUNTERSIGNED (Date) BY (Authorized Representative THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS, COVERAGE PART COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. JDL 190 (0)-0 (Ed. 11-85) Includes copyrighted material of Insurance Service Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1983, 1984, 3/24/10 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS New Business Declarations POLICY NO: 1CT0637621/CO-0100001/A01 NAMED INSURED: GARRY BJORKLUND DBA PROFESSOR MUNCHIE LIMITS OF INSURANCE: GENERAL AGGREGATE LIMIT (Other than Products -Completed Operations) 2,000,000 PRODUCTS —COMPLETED OPERATIONS AGGREGATE LIMIT 2,000,000 PERSONAL & ADVERTISING INJURY LIMIT 11000,000 EACH OCCURRENCE LIMIT 1,000,000 FIRE DAMAGE LIMIT 50,000 ANY ONE FIRE MEDICAL EXPENSE LIMIT 5,000 ANY ONE PERSON FORM OF BUSINESS: (X) Individual ( ) Partnership ( ) Joint Venture ( ) Other: This is an Occurrence (X) / Claims —Made ( ) policy. If this is a Claims —Made policy, Coverage A of this insurance does not apply to "Bodily Injury" or "Property Damage" which occurs before the Retroactive Date shown here: LOCATION OF ALL PREMISES YOU OWN, RENT OR OCCUPY: 1801 RIVERSIDE AVE FT COLLINS CO 80525 CLASSIFICATION CODE NO. PREMIUM BASIS RATES ADVANCE PREMIUMS PR/CO ALL OTHER PR/CO ALL OTHER Restaurants with less than 30% sale of 16910 110,000 ( ) 1.097 11.254 121 1,238 alcoholic beverages Addt'l Insured -Managers or Lessor Of Premises CG2011 ( ) 5 CITY OF FORT COLLINS PURACHASING DEPT PO BOX 580 FT COLLINS CO 80522-0580 CITY OF FORT COLLINS PURCHASING DEPT. PO BOX 580 Deductible Liability Insurance CG0300 ( ) Property Damage Liability $ 250.00 ded per claimEPT. PO BOX 580 Exclusion Explosion, Collapse and Underground CG2142 All locations & operations Excluded Hazard(s): Explosion, Collapse and Underground PD (p) = per 1,000 of payroll (a) = Total Area---------------------- (s) = per 1,000 of sales (t) = Total Sales Total 121 1,243 ENDORSEMENTS ATTACHED TO THIS COVERAGE FORM: CG0001 (12-04) CG0067 (03-05) CG0300 (01-96) CG2142 (12-04) CG2147 (07-98) CG2149 (09-99) CG2167 (12-04) CG2170 (01-08) CG2407 (01-96) NEN8139 (04-94) PG947 (01-05) CG2011 (01-96) CL 150 (11/85) 3/24/10 o 1 I CUSTOMER NO. r. n _ jC�yrfr� NATIONAL FARMERS UNION ti%W PROPERTY AND CASUALTY COMPANY 5619 DTC Parkway Suite 300 Greenwood Village, CO 80111-3136 WWW.NFUIC.COM TARGET RISK POLICY 12:01 A.M. STANDARD TIME AT THE 1CT0637621 2/22/10 2/22/11 ADDRESS OF THE NAMED INSURED C0000210 NAMED INSURED AND ADDRESS AGENT ADDITIONAL INSURED: CITY OF FORT COLLINS JOHN C NOLAND PURACHASING DEPT DBA NOLAND INDUSTRIES PO BOX 580 121 E SWALLOW RD # 115 FT COLLINS CO 80522-0580 FORT COLLINS CO 80525-2568 REINSTATEMENT NOTICE YOUR POLICY HAS BEEN REINSTATED AND IS ACTIVE THROUGH THE POLICY PERIOD SHOWN. INSURED: GARRY BJORKLUND DBA LOAN NO: