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HomeMy WebLinkAboutCONEJO AZUL - INSURANCE CERTIFICATE (3)6/11/2010 10:58 AM FAON: Fax Welsh Insurance Agency TO: 1-970-221-6707 FTGE: 002 OF 002 a` ad CERTIFICATE OF LIABILITY INSURANCE DA06MMIDon " PRODUCER Welsh Insurance Agency, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 4033 Boardwalk Drive, Suite #200 Fort Collins, CO 80525 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # Phone (970)206-1810 Fax (970)206-1808 wBUREO Conejo Azul, Inc. 410 S. Grant Ave. INSURERA: AUTO -OWNERS INSURANCE CO INSURER B: INSURER C: Fort Collins, CO 805212539 INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIIY) POLICY EXPIRATION DATE (MMIDOM) LIMITS GENERAL LIABILITY EACH OCCURRENCE 500,000 Q COMMERCIAL GENERAL LIABILITY 74926439 08/28/09 08/25/10 PREMISES Ea occurence 300,000 A ❑❑ CLAIMS MADE ❑O OCCUR ❑ NED EXP (Any one person) 10,000 PERSONAL SADVINJURY 5 00,000 ❑ GENERAL AGGREGATE 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP ADS 1,000,000 © POLICY [—]PROJECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANYAUTO COMBINED SINGLE LIMIT (Ea accident) ❑ ❑ ALLOWNEDAUTOS ElSCHEDULED SCHEDULED AUTOS ❑ HIREDAUTOS ❑ NON OWNED AUTOS INJURY BODILY rp BODILY INJURY (Per accident) ❑ PROPERTY DAMAGE (Per accident GARAGE LIABS-ITY AUTO ONLY- EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EAACC AUTO ONLY: AGG LLA LIABILITY EACH OCCURRENCE ❑ CLAIMS MADE r AGGREGATE ES ION AND EMPLOYERS' LIABILITY WC STATU- OTH- ❑ TORY LIMITS ❑ R E.L. EACH ACCIDENT ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? E.L. DISEASE - E4 EMPLOYEE If yes, desedos under E.L. DISEASE - POLICY LIMIT SPECIAL PROVISIONS balm OTHER DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS HOT DOG STAND CITY OF FORT COLLINS IS LISTED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Fort Collins - PURCHASING DEPARTMENT 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO Attn: Purchasing Department PO BOX 580 THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Q �. SIaAAC FORT COLLINS, CO 80524 1221-6707 ACORD 25 (20U1/08) QF (DACORD CORPORATION 1988