HomeMy WebLinkAbout103133 BOB'S APPLIANCE SERVICE - INSURANCE CERTIFICATE (2)BOBSA-1 OP ID: LD
'4�� CERTIFICATE OF LIABILITY INSURANCE
DATE(M2911YYY)
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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 endorsemen s .
PRODUCER Phone: 970-482-7747
Brown & Brown Inc
4532 Boardwalk Dr, Suite 200 Fax: 970-484-4165
Fort Collins, CO 80525
House Account
CONTACT
NAME:
Pp� No Ezt: A/C No:
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC N
/J._
INSURER A: Allied Property and Casualty
42579
J
INSURED Bob's Appliance Service
International Ventures Inc DBA
INSURER B:
225 Smokey St
INSURER C :
INSURER D :
Ft Collins, CO 80525
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 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.
INSR
TR
TYPE OF INSURANCE
POLICY NUMBER
MMIDDNYYY
MPOLICY
DDIYYYY
LIMITS
A
GENERAL LIABILITY
COMMERCIALGENERAL LIABILITY
CLAIMS -MADE OCCUR
X Business Owners
ACP7544462047
05101114
05/01/15
EACH OCCURRENCE
$ 2,000.00
PREMISES (Es occurrence
$ 300000
MED EXP(My we person)
$ 5,00
PERSONAL S ADV INJURY
$ 2,000,00
GENERAL AGGREGATE
$ 4,000,00
GENL AGGREGATE LIMIT APPLIES PER:
POLICY PRO -CT n LS
PRODUCTS - COMPIOP AGG
$ 4,000,00
$
A
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
X HIRED AUTOS X AUT SEED
ACP7544462047
05101/14
05/01/15
COMBINED SINGLE UNIT
Ease ant
2000r00
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTYDMIAGE
Peramidenl
$
$
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS-MAOE
i
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTHERIEXECUTME ❑
MI OFFICEREMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
WC STATU- IOTH-
T RY MIT ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, If more apace Is required)
CITYOF
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, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
t�-P 60
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD