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HomeMy WebLinkAboutTACOS ON THE STREET - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY)
07/27/2011
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Western Insruance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1520 E. Mulberry St. Ste 140 _ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins, CO 80524
INSURERS AFFORDING COVERAGE
INSURED Tacos on the Street
702 Crown Ridge Lane #3
Fort Collins CO 80525
COVERAGES
NAIC #
THE POLICIES OF INSURANCELISTED BELOW HAVE BEEN ISSUEDTOTHE INSUREDNAMEDABOVE FORTHE POLICY PERIODI NDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN, THE I NSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS, EXCLUSIONS ANDCONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADD -
POLICY NUMBER
POLICY EFFECTIVE
DATE dmmunniYyyy,i
POLICY EXPIRATION
DATE MMInnfYYYYi
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000 000
DAMAGE TO -RENTED
$1,000,000
A
X COMMERCIAL GENERAL LIABILITY
91SBMZ11549
08/01/2011
08/01/2012
CLAIMS MADE FX I OCCUR
MED EXP (Any oneperson)
10,000
PERSONAL B ADV INJURY
$1,000,000
GENERAL AGGREGATE
$ 2,000 000
GEN'L AGGREGATE
LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
f2,000,000
17 POLICY
PRO- LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$ '
OTHER THAN EA ACC
$
ANY AUTO
IS
AUTO ONLY: AGG
EXCESS
/ UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOWPARTNEWEXECUTIVLT�
OFFICER/MEMBER EXCLUDED? LJ
WCSTATU- X OTH-
E.L. EACH ACCIDENT
$
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$
OTHER
TIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
is also Additional Insured
r
City of Fort Collins
P.O. Box 580
Attn: Purchasing Division
Fort Collins, CO 80522
Phone:
I Fax: (9701221-6707
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (20091011
988.2009 ACORD CORPORATION. All rights reserved_
The ACORD name and logo are registered marks of ACORD
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 certificate
holder in lieu of such endorsement(s).
DISCLAIMER
This Certificate of Insurance 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.
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