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HomeMy WebLinkAboutVON JON INC (TRIBAL RITES & LA FAMILIA TATTOO) - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE DATE(M 6M /9 Y2011 PRODUCER (415) 475-4300 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE PROFESSIONAL PROGRAM INSURANCE BRORERAGE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 371 BEL MARIN KEYS BLVD., SUITE 220 POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # NOVATO CA 94949-5662 _ INSURED INSURER ALLOYD'S OF LONDON VON JON, INC. INSURER B: DBA: TRIBAL RITES S LA FAMILIA TATTOO 632 SOUTH COLLEGE AVENUE FORT COLLINS, CO 80524 INSURER C'. INSURER D: INSURER E COVERAGES 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 MAYBE 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 ADO'L POLICY EFF C➢V POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MW0OYY DATE MMIDONY LIMITS A X GENERAL LIABILITY / / / / EACH OCCURENCE $ 500,000 $ 50,000 X COMMERCIAL GENERAL LIABILITY MED EXP IAny one person) $ 1,000 X CLAIMSMADE OCCUR PB/10-1883 6/12/2011 6/12/2012 PERSONAL AND ADV INJURY $ 500,000 X PROFESSIONAL LIAB. GENERAL AGGREGATE $ 500,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AS $ COMMUNICABLE DISEASE $50,000 X POLICY PROJECT LOC / / / / AUTOMOBILE UABILRY ANY AUTO / / / / COMBINED SINGLE LIMIT (Ea. evident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS / / / / NON-OWNEDAUTOS PROPERTY DAMGE (Per accident) $ GARAGE LIABILITY AUTO ONLY -EA. ACCIDENT $ ANY AUTO / / OTHER THAN EA ACC $ AUTO ONLY: ADD $ EXCESSNMBRELLA LIABILIT OCCUR ❑ CLAIMS MADE / / , / EACH OCCURENCE $ AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'UASIUTY / / / / WCSTATU- TORY LIMITS I OTH- ER ANY PROPRIETORIPARTNER/ ECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? It yes. describe under / / / / E.L. DISEASE -EA EMPLOYEE$ E.L. DISEASE-POUCY LIMIT $ SPECIAL PROVISIONS below I OTHER DESCRIPTON OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER THE ATTACHED ENDORSEMENT. BUSINESS LOCATIONS: (1) 632 SOUTH COLLEGE AVENUE, FORT COLLINS, CO 90524 (2) 636 SOUTH COLLEGE AVENUE, FORT COLLINS, CO 80524 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WIL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVESI CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO 80522 INZA ZO (OIW).05 ELECTRONIC LASER FORMS, INC.-ISWI32T-0545 Page 1 of IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 certtificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) INS025 imaal.aa P,.2m2 POLICY NUMBER: PB/10-1888 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE: SCHEDULE Name of Additional Insured Person(s) or Organization(s) City of Fort Collins PO Box 580 Fort Collins CO 80522 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section R -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf. A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1