HomeMy WebLinkAboutTACO NATION - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE I
DATE(MM/DD/YYYY)
PRODUCER
Western Insruance Services
1520 E. Mulberry St. Ste 140
Fort Collins, CO 80524
INSURED Tacos on the Street
702 Crown Ridge Lane #3
Fort Collins CO 80525
[KUTI �:7[eT�-1
0711312010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
The Hartford
COVERAGE
NAIC #
THE POLICIES OF INSURANCE LISTEDBELOW HAVE BEEN ISSUEDTOTHEINSUREDNAMEDABOVE FORTHEPOLICY PERIODINDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN, THE INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INBR
JL.IM&
DD'L
TYPE OF INSURANCIP
POLICY NUMBER
POLICY EFFECTIVE
DATE IMMIDDIYYYYI
POLICY EXPIRATION
DATE 1MNVDOA(YYYI
LIMITS
GENERAL LIABILITY
I08/01/2011
EACH OCCURRENCE
E 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
91SBMZI1549
08/01/2010
DAMAGE TO RENTED
$1,000,000
MED EXP (Any oneperson)
CLAIMS MADE F—XI OCCUR
$ 10,000
PERSONALS ADV INJURY
$1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE
LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2,000,000
POLICY
PRO- LOG
AUTOMOBILE
LIABILITY
ANY AUTO
_
COMBINED
Eaaccident' SINGLE LIMIT
$
BODILY INJURY
(Per person)
ALL OWNED AUTOS
SCHEDULED AUTOS
$
BODILY INJURY
(Per accident)
HIRED AUTOS
NON -OWNED AUTOS
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
_
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS
/ UMBRELLA LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
8 _
DEDUCTIBLE
1
$
RETENTION $
'IANDEMPLOYERS'LIABILITY
I
WORKERS COMPENSATION
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVEr-7
OFFICERINIEMBER EXCLUDED?
WC STATU- X OTH-
FR
E
E.L. EACH ACCIDENT
E.L. DISEASE- EA EMPLOYEE
$
(Mandatory In NH)
It yes, describe under
E.L. DISEASE - POLICYI RUT
$
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Certificate Holder is also Additional Insured
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
P.O. Box 580 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Purchasing Division IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins, CO 80522 REPRESENTATIVES.
Phone: AUTHORIZED REPRESENTATIVE
Fax: .1
ACORD 25 (2009/01) n 19RR_7nno nrnen r-nwanPATlnrd AN AI H.e .ewe —A
The ACORD name and logo are registered marks of ACORD
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
ACORD 25