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Home My WebLink AboutTUMBLEWEED SUPER TASTY TREATS - INSURANCE CERTIFICATE (3)From: Joan DeLauder At: Brown and Brown of Colorado, Inc. FaxID: (970) 484-4165 To: David Carey Date: 5/312011 02:14 PM Page: 1 of 2 A OR� CERTIFICATE OF LIABILITY INSURANCE OP ID JG DATE IMMIDDIYYYY) 05/31/11 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 po cy es must be endorsed. 11 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 Brown S Brown Inc 125 S Howes, 5th Floor NAME; Joan DeLautler S C.No.En1: 970-494-4677 lac, Nq): 970-482-774 ADDREss: jdelauder@bbcolorado.com P 0 Box 2226 Fort Collins CO 80522-2226 CUSTOMERIDt. TU11BL-1 Phone:970-482-7747 Fax:970-484-4165 INSURER(S) AFFORDING COVERAGE NAICi INSURED INSURER A: Auto —Owners Insurance CO. 18988 Tumbleweed Super Tasty Treats David Ammann dba INSURER B: INSURER C: 525 Peterson Street Fort Collins CO 8DS24-3137 INSURER D : INSURER E 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. NOTWITSTMDINGANYREOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICHTHIS 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. LTR TYPE OF INSURANCE INSR W POLICY NUMBER (MMIDDJY1YYl (MMIDDMYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000 A X COMMERCIALGENERAL LIABILITY 74857090 06/28/10 06/28/11 PREMISES(EO occurrence) $ 300,000 CLAIMS -MADE OCCUR MED EXP(My one person) $10,000 PERSONAL B ADV INJURY $500,000 X GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $1,000,000 POLICY PEp LOS $ AUTOMOBILE LNBILT( COMBINED SINGLE LIMIT Ea acodert) $ MY AUTO BODILY INJURY (Per person) $ ALL OWNED P1JT08 BODILY INJURY (Par ecadeN) $ SCHEDULED AUTOS HIREDAUTOS PROPERTY DAMAGE (Per accident E NONOWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CC.111MPDE AGGREGATE $ DEDUCTIBLE g $ RETENTION $ IT AND EMPLOYERSLIABILITY YIN MY PROPRIETOR/PARTNER/EVECUTIVE ❑ OFFICERIMEMSER EXCLUDED? 41A TORY LIMITS M FFI ER ELEACH ACCIDENT $ E. L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) It Yes, describe under E. L, DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS be. DESCRIPTON OF OPERATIONS I LOCATIONS I VEHICLES (Mach ACORD 101. Additional Remarks Schedule, If more apace Is required) Concessionaires. Certificate Holder is named as Additional Insured as respects the General Liability and operations of the named insured. Attn: David Carey FAX: 970-221-6707 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FTCOLLI I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ft. Collins Building Department 281 N College Avenue (Fort Collins CO 8052. CORPORATION. All rights ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD From: Joan DeLauder At: Brown and Brown of Colorado, Inc. FaXID: (970) 484-4165 To: David Carey Date: 5/312011 02:14 PM Page: 2 of 2 A ORbP CERTIFICATE OF LIABILITY INSURANCE OPID JO DATE (MM31 Y) 05/31/11 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 po cy es must be endorsed. if SUBROGATION IS WAV D, 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 Ileu of such endorsement(s). PRODUCER Brown 6 Brown Inc 125 S Howes, 5th Floor NAME; Joan DeLauder LAIC, No. eAn 970-494-4677 (AIc. Nor 970-482-779 ADDRESS: jdelauder@bbcolorado.com P O Box 2226 Fort Collins CO 80522-2226 CUSTOMER IDt TUtdBL-1 Phone:970-482-7747 Fax:970-484-4165 INSURER(S) AFFORDING COVERAGE NAIC* INSURED INSURER A: Auto -Owners Insurance Co. 18988 Tumbleweed Super Tasty Treats David Ammann dba INSURER B: INSURER C: 525 Peterson Street Fort Collins CO 80524-3137 INSURER D INSURER E 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSLRNJCE 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 LTR TYPE OF INSURANCE Iggq POLICY NUMBER (MMIDDIYWY) (MMNDM`YY) LIMITS GENERAL LLIBILRY EACH OCCURRENCE $SOO,000 PREMISES(Eaarlp ree) $300,000 A X COMMERCIALGENERAL-LIABIL[TY 74857090 06/28/10 06/28/11 CLNMS-MADE rx] OCCUR MED EXP (Any orle person) $ 10 , 000 PERSONAL &ABV INJURY $500,000 X GENERAL AGGREGATE s1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 1,000,000 POLICY dEGa'T LOC Is AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ MY AUTO BODILY INJURY (Perperson) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ NON -OWNED ALITOS $ UMBRELLA LMB OCCUR EACH OCCURRENCE $ EXCESS LAS CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER EL EACH ACCIDENT $ MY PROPRIETORIPARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? I A E. L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, deacnoe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional RamarI Schedule, It men apace la r.,.Ir.d) Concessionaires. Certificate Holder is named as Additional Insured as respects the General Liability and operations of the named insured. Attn: David Carey FAX: 970-221-6707 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FTCOLLI I THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ft. Collins Building Department 281 N College Avenue ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD