HomeMy WebLinkAboutTUMBLEWEED - INSURANCE CERTIFICATE (4)From: PaUla Kerrigan At Brown and Brown of Colorado, Inc. FaxID: (970) 484-4165 To: City of Fort Collins
h' Date6/112010 01:47 PM Page: 2 of 2
PRODUCER
CORD CERTIFICATE OF LIABILITY INSURANCE Tu�z
Brown & Brown Inc THIS CERTIFICATE IS ISSUED AS A MATTER
125 S Howes, 5th Floor ONLY AND CONFERS NO RIGHTS UPON THE
HOLDER. THIS CERTIFICATE DOES NOT AME
P O Box 2226 Fort Collins CO 80522-2226 ALTER THE COVERAGE AFFORDED BY THE
Phone:970-482-7747 Fax:970-484-4165 INSURERS AFFORDING COVERAGE
INSNRFrt _
INSURER A
Tumbleweed Super Tasty Treats INSURER B.
David Ammann dba INSURER
525 Peterson Street INSURER D.
Fort Collins CO 80524-3137
INSURER E.
DATE (MMIDDMTYI
06/11/10
iMATION
CATE
END OR
i BELOW.
NAIC A
18988
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
MY REQUIREMENT, TERM OR CONDITION OF MY 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
LTR
NSR
TYPE OF INSURANCE
GENERAL LIABILITY
POLICY NUMBER
DATE (MWDDIYY)
DATE (MMMDM)
LIMITS
A
$
BILITY
$ COMMERCIAL GENERAL ]]CCU&i
CLAIMS MADE OCCUR
0623327485709009
06/28/09
06/26/10
EACH OCCURRENCE
$500,000
PREMISES (Ea occurence)
$300,000
MED EXP (Any one person)
$ 10,000
PERSONAL&ADV INJURY
$500,000
GEN'L AGGREGATE L IMITAPPLIES PER
GENERAL AGGREGATE
$1,000,000
PRODUCTS - COMP{OP AGG
$I, OOO,OOO
PRO-
POLICY JECT LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea acciderrt)
$
ALL OWNED AUTOS
BODILY INJURY
(Per Person)
$
SCHEDULED AUTOS
HIREDAUTOS
BODILY INJURY
(Per accident)
$
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per ecclderlt)
If
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
:
AUTO ONLYASS
$
E%CESSNMBRELLq LIABILITY
$
OCCUR CLAIMS MADE
EACH OCCURRENCE
$
AGGREGATE
If
$
DEDUCTIBLE
RETENTION g
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
TORY LIMITS ER
E L. EACHACCIDENT
$
EL DISEASE - EA EMPLOYEE
$
If yes, describe under
SPECIAL PROVISIONS below
EL DISEASE -POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT l SPECIAL PROV510NS
Concessionaires.
Certificate Holder is named as Additional Insured as respects the General
Liability and operations of the named insured.
Attn: Christine Jarvis FAX: 970-221-6707
CERTIFICATE HOLDER ,,.......... _._..
FTCOLLI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CitDATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
Building Department of Ft. Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Buil
281 N College Avenue IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins CO 80522 REPRESENTATIVES.
AUTH DREPRESENTATIVE