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Home My WebLink AboutVON JON INC (TRIBAL RITES & LA FAMILIA TATTOO) - INSURANCE CERTIFICATE (2)ACORD CERTIFICATE OF LIABILITY TN INSURANCE DATE (M/018 20 6/1/12 PRODUCER (415) 475-4300� THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND '� .'::o .;., CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE PROFESSIONAL PROGRAM INSURANCE BROKERAGE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 371I BEL MARIN KEYS BLVD. , SUITE 220 POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# NOVATO — CA. 94949-5662, INSURED INSURER A: LLOYD'S OF LONDON VON JON, INC. INSURERB. DBA: TRIBAL RITES S LA FAMILIA TATTOO INSURER C: 632 SOUTH COLLEGE AVENUE FORT COLLINS, CO 80524 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 CONTRACT OR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICYEFFECTIVE POLICYEXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/ODlYY DATE MM OM' LIMITS A X GENERAL LIABILITY / / / / EACH OCCURENCE $ 500,000 PREMISESEa. occumence $ 50,000 X COMMERCIAL GENERAL LIABILITY MED EXP(Any one Person) $ 1,000 X CLAIMSMADE OCCUR PB/11-1830 6/12/2012 6/12/2013 PERSONAL AND ADV INJURY $ 500,000 X PROFESSIONAL LIAB. • / / GENERAL AGGREGATE $ 500, GOO GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP,OP AG $ COMMUNICABLE DISEASE $50,000 X POLICY PROJECT LOC / / / / _ .. AUTOMOBILE -. LIABILITY, ANY AViO _. _ •- COMBINED SINGLE LIMIT (Ee. acdEem) $ BODILY INJURY' (Per person) - S,r••_)_{Iq• ALLOWNEDAUTOS '• SCHEOULEDAUTOS ' BODILY INJURY (Per ec.ident) • HIREDAUTOS / / '/ V - NON -OWNED AUTOS PROPERTY OAMGE S (Per ePGeenl) GARAGE UABILNY AUTO ONLY -EA. ACCIDENT S ANYAUTO / / / / OTHER THAN EAACC $ AUTO ONLY: AEG S EXCESSNMBRELLA UABILIT OCCUR I] CLAIMS MADE / / / / EACH OCCURENCE S AGGREGATE $ 5 DEDUCTIBLE / / / / $ RETENTION S $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY / / / / WC Y L..T TORY LIMITS DTH� ER ANY PROPRIETOWPARTNEMEXECUTIVE E.L. EACH ACCIDENT $ OFFICEMMEMBER EXCLUDED? If yes. eesoibe uncer / / / / E.L. DISEASE -EA EMPLOYEES E. L. DISEASE POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTON OF OPERATION$LOCATIONSNEHICLEVEXCLUSIONS ADDED BY ENDORSEMENTJSPECIAL PROVISIONS CERTIFICATE HOLDER IS NAND AS ADDITIONAL INSURED PER THE ATTACHED ENDORSEMENT. BUSINESS LOCATIONS: (1) 632 SOUTH COLLEGE AVENUE, FORT COLLINS, CO 80524 (2) 636 SOUTH COLLEGE AVENUE, FORT COLLINS, CO 80524 CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS P.O. BOX 580 FORT COLLINS, CO 80522 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 REPRESENT9iNE$1 IN5025 (OIDB)D5 ELECTRONIC LASER FORMS, INC .-(e00)B2)-0545 P., 1.12 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 (2001/09) INS025 fonoa)m Page 2 of POLICY NUMBER: PB/11-1830 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 P.O. Box 580 Fort Collins CO 80522 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - 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 0ISO Properties, Inc., 2004 Page 1 of 1