HomeMy WebLinkAboutVENDING SERVICES OF COLORADO - INSURANCE CERTIFICATE (4)®® CERTIFICATE OF LIABILITY INSURANCE OP ID DA
5I1E(MM/DDMYY) '
12/19 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 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
NAME:
Brown Fi Brown Inc
HONE FAA
AIC,_N�Eati: (A_IC, N.).
_
ADDRESS:
4532 Boardwalk Dr, Suite 200
Fort Collins CO 80525
RODUCER— - --
CUSTOMERIDA: VENDI-1
P one: 970-462-7747 Fax: 970-484 -4165
INSURER(S)AFFOROING COVERAGE
NAIC0
INSURED
ante Com an
INSURER A: P1nndC01 Assurance �.�x_
41190
Vending Services Of Colorado
Inc.
INSURER B: pepoeitoxa Insurance company
.._.._.___.
42567
.._......_. _.._.._.__.......
INSURER C:---
__......
__..
5442 Boeing Dr j
Loveland CO 80538
..--._.. ------ ---..
INSURER D:
SURE0. E
NIN
INSURER F
CUVtKAGtS CERTIFICATE NUMBER: RFVISInN NiluRFR.
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 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.
INSR
... _.—ADD
TYPE OF INSURANCE
INSR
SUBq
WVD
_-'.-.._
POLICY NUMBER
POLrCVE'FF
(MM/DD/Y1'YY
TD
(MMIDDI E3
Y LIMITS
GENERAL LIABILITY
__.
EACH OCCURRENCE
$ 1, QOO, OOO
000
B
X COMMERCIALGENERALLIABILITY
I- CLAIMS -MADE OCCUR
ACP7514279024
12/19/11
12/19/12
AMAGETO RERTF�._.._.._._.__,
PREMISES(Eaoccurrence)
-
$3001000
MED EXP(Anyone person)
$ 5, 000
rX Business Owners
PERSONAL& ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN L AGGREGATE LIMIT APPLIES PER.
_
PRO -
POLICY[-� JECT LOC
1
PRODUCTS - COMP/OP AGG
! E 2, OOO, OOO
$
B
AUTOMOBILE
LIABILIT
ANY AUTO.
ALL OWNED AUTOS
I
t
IACP75J.4279024
12/19/11
[12/19/12
I
COMBINED SINGLE LIMIT
(Ea actltlenl)
--_........_ ......____._._.
BODILY INJURY (Per person)
s1,000,000
_._______...._...
$
X
-"--
BODILY INJURY (Per accident)
$
I
SCHEDULEDAUTOS
_
PROPERTY DAMAGE
(Per accidem)
_
'$
HIRED AUTOS
NON -OWNED AUTOS
I
$
UMBRELLA LIAR OCCUR
EACH OCCURRENCE
$
EXCESS LIAR
�LCIAIMS-MADE
)
.._.........._. ......-.__...�...—...__.._.
AGGREGATE is
DEDUCTIBLE
v
$
RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y IN
ANY PROPRIETORIPARTNERIEXECUTIV
OFFICER/MEMBER EXCLUDEDI
IA
4104021
10/O1/11
10/O1/12
X -
TORY L MITS ER
E.L. EACH ACCIDENT
$ 100000
E.L. DISEASE - EA EMPLOYEE)
$ 10 0 0 0 0
(Mane atory in NH)
xes. d PTION under
l Iy-SCRIscdbe OF b
OPERATIONS
E.L. DISEASE - POLICY LIMIT
$500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
970-224-6134
L,tK I IrIL.AI t KULL1tK CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYFIO I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins`"��`r�`"���`
215 N. Mason St. tea, --� *\ / ,
ACORD 25 (2009109)
ACORD
the ACORD name and logo are registered marks of ACORD
reserved.