HomeMy WebLinkAboutCOOKIE MIKE LLC - INSURANCE CERTIFICATE (2)COOKI-1 OP ID: P6
'44Cc;PMCERTIFICATE OF LIABILITY INSURANCE
DAT01102115 )
F
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 endorsements .
PRODUCER Phone: 970 482-7747
Brown & Brown Inc Fax: 970-484-4165
4532 Boardwalk Dr, Suite 200
Fort Collins, CO 80525
House Account
NAMEONTACT
PNONE FA%
ac No EA , ac No
E-MAIL
ADDRESS:
INSURERIS) AFFORDING COVERAGE
NAIC R
INSURER A: Continental Casualty Company
20443
INSURED Cookie Mike, LLC
INSURER B: Travelers Indemnity Company
25658
123 N College Ave #106
Fort Collins, CO 80524-2489
NsuRERc:
INSURER D :
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
LTRJum
rypE OF INSURANCE
ADD
9A
POLICY NUMBER
MMIDDIYEFF ' "Y
XP
MMIDUM/YY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,00
A
X COMMERCIAL GENERAL LIABILITY
B4024288877
11/17/14
11/17/16
PREMISEGg ( a acw Sante)
S 300,00
CLAIMS -MADE FXI OCCUR
MEDEXP(Any one person)
$ 10,00
PERSONAL BADVINJURY
$ 1,000,00
X Business Owners
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER.
PRODUCTS - COMP/OP AGG
$ 2,000,00
$
POLICY PRO- JFCT LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea acdden0
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
PROPERTY DAMAGE
Per accident
$
NON -OWNED
HIRED AUTOS AUTOS
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION $
S
B
WORKERS COMPENSATION
AND EMPLOYERS' LULBHJW
ANY PROPRIETORIPARTNER/EXECUTIVE YIN
IKUB9C23934914
03/01/14
03/01/15
X WC R ST'TU- OTH-
E.L. EACH ACCIDENT
$ 100,00
OFFICERIMEMBER EXCLUDED,
(Mandatory In NH)
N I A
E.L. DISEASE-EAEMPLOYEE
E 100,00
t1 yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
E 500,00
PROPERTY 216,48
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AKach ACORD 101, Addltlonal RamarMs Schedule, If mom apace is required)
CITYFC2
City of Fort Collins
PO Box 580
Fort Collins, CO 80524
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
S -G�L. 2.
9)1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD