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HomeMy WebLinkAboutTHE TACO STOP - INSURANCE CERTIFICATEncoRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `� 10/25/2013 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 CONTACT NAME: Talran J. QUarn Mountain Plains Agency, LLC PHONE AX N ; 9702060801 E-MAIL ADDRESS: 4532 McMurry Avenue Suite 150 INSURERS AFFORDING COVERAGE NAICN INSURER A: Mount Vernon Fire Insurance Company Fort Collins CO 80525 INSURED Bernice Longoria INSURER B : The Taco Stop INSURER C . 1207 Pomona Street INSURER O: Fort Collins CO 80521 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I TR TR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER Mks ODYIYYYY MM IDY E%P LIMITS A GENERAL LIABILITY X COMMERCIALGENER�ALLIABILITY CLAIMS -MADE XIOCCUR 1 ' A 1 "" CL2647205 08/19/2013 08/19/2014 EACH OCCURRENCE $ 100 O to PREMISES Ee memos)acw $ loom MEDEXP(Anyoneperel $ 5000 PERSONAL It ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GENL AGGREGGATIE X POLICY UNIT APPLIES PER I Pa LOC PRODUCTS -COMPIOP AGO $ 1000000 S AUTOMOBILE LIABILITY ANV AUTO ALL OWNED SCHEDULED AUTOS AUTOS NOON -OWNED HIRED AUTOS qAUTOS IL F— COMBINEDSINGLELIMIT (Es t BODILY INJURY (Par person) S BODILY INJURY (Par accident) E PROPERTY DAMAGE Peraccidemt $ $ UMBRELLA LIMB EXCESS LIMB OCCUR CLAIMS.MADE EACH OCCURRENCE S AGGREGATE S DIED RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y PROPRIETOFJPARTNERIEXECUTIVE YINAN OFFICEIMEMBER EXCLUDED? (Mandatory In NH) If yes, descnbe under N/A ^I I I _ WCSTATU- otH- I TOW LIMITS ER E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT E I^I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AUKh ACORD 101, Additional Remarks Schedule, S more space M reculred) Concession stand City of Fort Collins is listed as additional insured in respects t0 General Liability e-FRTIFICATF HnI nFR CANCELLATION City Of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE ANC LLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WIL BE D LIVERED IN Attn: Purchasing Dept ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE ---_. Fort Collins CO 80522 Tairan J. Quam ©1988-24f0 ACORD CORPOR Tq ION.'AN wil" reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1v►