HomeMy WebLinkAboutHYNDS BROS INC DBA JIMMY JOHN'S - INSURANCE CERTIFICATEHYNBR
Client#: 37959
ACORD. CERTIFICATE OF LIABILITY INSURANCE
r DATE(MMIDD/YYYY)
02/14/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER
Love, Douglas & Pope, Inc.
3480 Preston Ridge Road
Suite 100
CONTACT NAME: Debbie Stewart
PHONE 770 674-3000 AIC, N.J. 770 674-3080
(AIC, No Ezt
E-MAIL ADDRESS: @ dstewart//�P
Id f.com
rraDDc
Alpharetta, GA 30005
CUSTOMER ID A:
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURED
Hynds Bros, Inc.
DBA Jimmy John's
133 South College Ave.
Fort Collins, CO 80524
INSURER A: Utica Mutual Insurance Company
INSURER B
INSURER C
INSURER D
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN R
TR
TYPE OF INSURANCE
L
B
POLICY NUMBER
MMIOD E/YYYY
MMIDD CY EXP
IVYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 51 OCCUR
CPP4017201
2113/2011
02/13/2012
EACH OCCURRENCE
$1 BBB 000
PREMISES Ea occurrence
$1,000000
MED EXP (Any one person)
$o
PERSONALS ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO JECTX LOC
PRODUCTS - COMP/OP AGO
$1,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CPP4017201
2/13/2011
02/1312012
COMBINED SINGLE LIMIT
(Ea accident)
E100B000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
A
X
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLMMS-MADE
CULP4017202
2/13/2011
02/1312012
EACH OCCURRENCE _
$3,000,000
AGGREGATE
$3 BBB BBB
DEDUCTIBLE
RETENTION $ 10000
$
X
E
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
WC STATU- OTH-
IE
E.L. EACH ACCIDENT
E
E.L. DISEASE - EA EMPLOYEE
E
E.L. DISEASE -POLICY LIMIT
1 $
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
The Umbrella policy is only excess over coverages reflected on this certificate.
Certificate Holder is an Additional Insured with regard to the insured's
(See Attached Descriptions)
City of Fort Collins
215 N. Mason Street
Fort Collins, CO 80521
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD CORPORATION_ All rights reserved
ACORD 25 (2009109) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S208927/M208926 DYS
DESCRIPTIONS (Continued from Page 1)
General Liability coverage for outdoor seating where required by a written contract/agreement.
Loc# 1 - 133 South College Ave.; Fort Collins, CO
AMS 25.3 (2009109) 2 of 2
#S208927/M208926