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HomeMy WebLinkAboutOLD TOWN SPICE SHOP LLC - INSURANCE CERTIFICATEOLDTO-6 OP ID: JN '4� o CERTIFICATE OF LIABILITY INSURANCE DATE 10128/2014 ) 10/28/2014 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(les) 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 endorsements . PRODUCER PFS Insurance Group -JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Johnstown Select Accounts CONTACT Johnstown Select Accounts PHONE FAx Arc No Eat :970-635-9400 ac No): 970-635-9401 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC d INSURERA -Acuitv Insurance Co. 14184 INSURED Old Town Spice Shop LLC Attn: Sandy Godbey 130 A So. College INSURER B: NsuRERc: INSURER D: Fort Collins, CO 80524 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NU$AnaR- 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 LTR rypE OF INSURANCE POLICY NUMBER POLICY EFF MWDD/YYYY POLICY EXP MM/DD/WYY LIMITS A X COMMERCIAL GENERAL LIABILITY culMs+dAOE OCCUR X Z06969 10/19/2014 10/19/2015 EACH OCCURRENCE $ 1,000,00 DAMAGETO HEWED PREMISES Ea om,nence $ 100,00 MED EXP(My one person) $ 10,00 PERSONAL S ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑ JECT LOC GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OPAGG E 2,000,00 $ OTHER AUTOMOBILE LUIBILITY COMBINED SINGLE LIMIT Ee accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) ( ) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ UMSRELLALIAB OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAR CLAIMS -MADE OEO I RETENTION$ S WORKERS COMPENSATION ANDEMPLOYERS'LUUNUTY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? O N/A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) 0 yes, describe and E. L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addidonel Remarks Schedule, may W attached If room space Is requlrsd) Retail Spice Shop/Where required by written contract or written agreement, certificate holder is included as additional insured under general liability coverage with respect to awning at insured premises. CITYFCI 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 TSOO."114 AGUKU GUNPUHATIUN. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD