HomeMy WebLinkAboutPIZZA CASBAH - INSURANCE CERTIFICATECERTIFICATE OF INSURANCE
This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
❑ STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
❑ STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated below:
Policyholder ZAHAKIS INC (dba Pizza Casbah)
Address of policyholder
Location of operations
Description of operations
126 W Laurel Fort Collins CO
MAY 2 12010
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims
POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
Effective Date Expiration Date
LIMITS OF LIABILITY
(at beginning of policy period)
96-G5-9299-9 F
Comprehensive 04/15/2010 04/15/2011
BODILY INJURY AND
______________________
Business Liability------_--
PROPERTY DAMAGE
This insurance includes:
------------------j
® Products - Completed Operations
❑ Contractual Liability
❑ Underground Hazard Coverage
Each Occurrence $ 1, 000, 000
❑ Personal Injury
❑ Advertising Injury
General Aggregate $ 2, 000, 000
❑ Explosion Hazard Coverage
❑ Collapse Hazard Coverage
Products - Completed $ 2, 000, 000
❑
Operations Aggregate
EXCESS LIABILITY
POLICY PERIOD
BODILY INJURY AND PROPERTY DAMAGE
Effective Date Expiration Date
(Combined Single Limit)
❑ Umbrella
Each Occurrence $
❑ Other
Aggregate $
Part 1 STATUTORY
Part 2 BODILY INJURY
Workers' Compensation
and Employers Liability
Each Accident $
Disease - Each Employee $
Disease - Policy Limit $
POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
Effective Dab EM*VUon Date
LIMITS OF LIABILITY
(at beginning of policy period)
THE CER i n•wA I E Or INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
Re: City of Fort Collins is named as additional insured as If any of the described policies are canceled before
their interests may appear its expiration date, State Farm will try to mail a written
notice to the certificate holder 10 days before
cancellation. If however, we fail to mail such notice,
Name and Address of Certificate Holder no obligation or liability will be imposed on State
City of Fort Collins
Farm or its agents or representatives.
Attn: Sales Tax �((
P O Box 580
Signature o orized Representative
Fort Collins, CO B0522-0580 Agent 05/20/10
Title Date
Agent's Code Stamp
AFO Code F625
558.964a.4 11-12-2002 P.N. In U.S.A.
S. YOUNIE 06-2207
FIRE 86
Rocky Mountain AFO F913