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HomeMy WebLinkAboutTHE UNAMI FOOD TRUCK CO LLC - INSURANCE CERTIFICATE8/29/2014 2:08 PM FROM: Be. Microsoft TO: 2216782 PAGE: 001 OF 001 s► fzn� CERTIFICATE OF LIABILITY, INSURANCE DATE08 9/14 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlfkate holder Is an ADDITIONAL INSURED, the PoIICYQes) must be endorsed. R 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 certlllcate holder In lieu of such endorsemends). PRODUCER CoRffclr NAME: Welsh Insurance Agency, Inc. allo 18081810 eNo : (970) 20ENEa: (970) 20f gooses. Bmce@mainsurmce.com 4033 Boardwalk Drive, Suite #200 INSURER(S) AFFORDING COVERAGE NAIC i Fort Collins, CO 80525 INSURER A: Auto Owners Insurance Co. 18988 Phone (970) 206-1810 Fax (970) 206-1808 INSURED INSURER B: INSURER C The Un i Food Truck Co,. LLC INSURER D : Pinnacol 2200 N Taft Hill Rd INSURER E Fort Collins, CO 80524 970 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 LTR TYPE OF INSURANCE AUDI. INSR UBR WVD POLICY NUMBER POLICY EFF MMDDMYY POLICY EXP IMWDDYYYY LIMBS A GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITY ❑ ❑ CIAIMSMADE © OCCUR 0 74977380 09ro12014 09A72015 EACH OCCURRENCE $ 1,000,000.00 ADAGE TO RENTED PREMISES Ea occurrercel $ 300,000.00 MED EXP(My one Person) $ 10,000.00 PERsoNu fl NOV INJURY $ 1 000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER. o POLICY ❑ PRO- ❑ LOC JECT PRODUCTS - COMPIOP AGO $ 2,000,000.00 $ A AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL O MdED SCHEDULED AUTOS AUTOS Q HIREDAUTOS AN DOWNED ❑ 4997738000 09ro12014 09A12015 CEa acadOMBINED SINGLE LIMIT edi $ 500,000.00 BODILY INJURY(Per person) $ BODILY INJURY IPeracciOeM $ P?Or EPT nDPMAGE $ $ ❑ UMBRELLA UAB ❑OCCUR ❑ EXCESSLIAB ggIMS-MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DEC) ❑ RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN MY PROPRIETORIPARTNERIEXECU➢VE OFFICERm1EMBER EXCLUDED? ❑NIA (Mandatory in NH) I yes. describe tole DESCR IPTION OF OPERATIONS belory 9323713 09/012014 09A12015 91WC STAR} OT& TDRY IMITS ER EL. EACH ACCIDENT $ 100,000.00 EL DISEASE - EA EMPLOYE $ 100.000.00 EL. DISEASE -POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AI ACORD 101, Additional Rematha Schedule, ITmors space is required) MOBILE FOOD SALES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF FORT COLLINS SALES TAX DIVISION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 N. MASON ST. 2ND FLOOR ACCORDANCE WITH THE POLICY PROVISIONS. FORT COLLINS, CO 80522-0580 AUTHORIZED REPRESENTATIVE F 221-6782 111)1989-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) OF The ACORD name and logo are registered marks of ACORD