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Home My WebLink AboutTUMBLEWEED SUPER TASTY TREATS - INSURANCE CERTIFICATE (4)From: Kathi Walsh At: Brown and Brown of Colorado, Inc. FaxID: (970) 484-4165 To: David Clark Date: 6232011 03:45 PM Page: 1 of 1 �!?v CERTIFICATE OF LIABILITY INSURANCE OPID KA DAE(MMDD/1 06/23/11 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: the certificate holder Is an ADDITIONAL INSURED, the po cy(es) must be endorsed. , 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 EUPI NAMEPHONE (AK, No, E,t): (AlC, No): Brown S Brown Inc LAMAI ADDRESS: 4532 Boardwalk Dr, Suite 200 Fort Collins CO 80525 CUSTOMERIDf. TUMBL-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 NSURED 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 SJB,ECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - LTR TYPE OF INSURANCE INSR WJD POLICY NUMBER (MMlDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000 A X COMMERCIALGENERALLIABILRY 74857090 06/28/11 06/28/12 PREMISES (Ed omunence) $300,000 CLAMSSIADE a OCCUR MEDEXP(Anyonepon,on) $10,000 PERSONAL BADV N-URY $ 500 , 000 X GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OPAGG $1,,000,000 PROT LOC POLICY F JEC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea eaitlent) $ ANY AUTO BODILY NJJRY(Per person) $ ALL OWNED AUTOS BODLY IN.URY(Pc amdent) $ SCHEDULED AUTOS IT RED AUTOS PROPERTY DAMAGE (Per eccioen0 $ NON -OWNED AUTOS $ LLA LIAB OCCUR EACH OCCURRENCE $ S LIAB CLANdSWADE AGGREGATE $ TIBLE F $ IF TION $ WORKERS COMFENSATON s AND EMPLOYERS' LIABILITY YIN TORY LIMITS I I ER E.L. EACH ACCIDENT $ MY PROPRIETOR/PARTNERrECECUTIVE[:J OFFICERNEMBER EXCLUDED? IA E. L. DISEASE -EA EMPLOYEE $ (Mandatory In NH) If yes. describe under E. L. DISEASE -POLICY LIMB 1 $ DESCRIPTION OF OPERATIONS Ind. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101. Addilonal Remarks Schedule, ltmore space israWired) 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 David Carey 281 N College Avenue 1886- 09 RATION. All rights ACORD 25 (2009109) The ACORD name and logo are roc;I7.0d.arks of CORD From: Paula Kerrigan At: Brown and Brown of Colorado, Inc. FaxID: (970) 484-4165 To: City of Fort Collins Date: 5/31/2012 10:06 AM Page: 1 of 2 INS_URAN, CIE 4532 Boardwalk Drive, Suite 200, Fort Collins, CO 80525 (970) 482-7747/Fax (970) 484-4165 MA A From: Paula Kerrigan To: Pages: 2 Fax: (970)221-6707 Date: 5/31 /2012 10:05:50 AM Phone: ( ) - Subiect: C01 Citv of Fort Collins Message: CONFIDENTIALITY NOTICE The information contained in this communication, including attachments is privileged and confidential. It is intended only for the exclusive use of the addressee. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited If you received this fax in error or would like to be removed from our fax list, please call (970) 482-7747. Thank you. From: Paula Kerrigan At: Brown and Brown of Colorado, Inc. FaxID: (970) 484-4165 To: City of Fort Collins �_231 CERTIFICATE OF LIABILITY INSURANCE Date: 5/312012 10:06 AM Page: 2 of 2 DATE (MM/DD/1'1'1'Y) OP ID PK 0 31/12 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 fJAME: PH (A/C, No, Extl: Blown S Brown Inc ADDRESS: 4532 Boardwalk Dr, Suite 200 FOIL Collins CO 60525 CUSTOMERID#: TUMBL-1 Phone:970-482-7747 Fax:970-484-4165 INSURER($) AFFORDING COVERAGE NAIC# INSURED INSURER A: Auto -Owners Insurance Co. 18988 Tumbleweed Super Tasty Treats David Ammann dba INSURER B: INSURERC: 525 Peterson Street Fort Collins CO 80524-3137 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THI= IS TO -ERT =1 TH-T THE FOLD-IES OF INSL FANCE LISTE_� BELFW WVE BEEN ISSUED -� THE INSHFED NFMED-BOVE FOR TIE PT JCY FERIOF INDI HTEL NOT VITHC VNDI'IG AN RED II REMENT TERM r- CONTITIOI, IF Al., ACI.TRAC LP r-HER T,CAH ENT ITH FESPD TTO HIAH THIS CEF IFIC-_E MP BE = CHEF OR MFT PEFTAIN. ITE 11, 1JRAISCEAFFDRE ED BY THE FLLICIEEDES -RIBEE HEF ON IS E1JB!E1_T TT,LL TIE TEFMS, ERC LISIC, IS ARE CONEITIOI,OF SLCH F �LICIEC LII4' TS SF AWN' WY H-VE SEEN FEDUCET BY FAID I_AIMS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER LIMITS GENERAL LIABILITY EA-HOT-JFFENCE $500,000 LD MISES IE $300,000 A X CEMME=TIAL -ENEF :LLI/--ILIT, 74857090 06/28/11 06/28/12 CL-IMS�L- r'ADE OCC MEC ERT ,Any C'Ie per -ion) $ 10,000 X PEE ON-_&AF,iIN!I_FY $500,000 OFJERALAGIFI-ATE $11000,000 ,EN 'L-GGRE=ATE TAIT-FPLIE, PEE RE �DUC-,-0MD/Or ADD $1,000,000 FHcL IECT LC'- $ AUTOMOBILE LIABILITY IT'ABINET SIN -LE Llt'IT (E, a OT,t) $ A IY ALL Br_JLV II.JUR'i Per F=rsonl $ A_L OW'IED A_HAS BCEILYII,LUR\ P.- id- $ ' HEDL_ELT P!T_S - ITFED FJTOS PF PERT, DAA'4GE (P—1,-nt) $ N Ft FO', TED FJTOS $ $ UMBRELLA LIAB ICI_F EA-HOr-URRENCE $ EXCESS LIAB CLAII.'-MACE AS =REG-TE $ D=DUT-6LE $ $ F' -TENT N $ WORKERS COMPEf SATION AND EMPLOYERS'LIABILITY YIN TOR LIMITS EF EL E CFA ENT $ .N FF FRIETYR/F FTNEF/E::E-UTI\�= - FFIC ER/MEtIBERE CLLi QED? /A E L DISE .SE . EMPLOYEE $ IM tl Cory in NH) `yes, ; cL t- undue =,ESCFPTIOIOFO-ERAT NSrE,, EL DISEASE- OLIC LIMA $ DESCRIPTION OF OPERATIONS, LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Sdhetlule. if more space is r.q.i,.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 THE EXPIRATION DATE THEREOF, 140TICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Ft. Collins AUTHORIZED REPRESENTATIVE David Carey 281 N College Avenue Fort Collins CO 80522 —(01`988-_200ACORV-CORPORATJDN. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD