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HomeMy WebLinkAboutWING SHACK ENTERPRISES INC - INSURANCE CERTIFICATE (3)WINGS-6 OP ID: B DATE(MM/DD/YYYY) 1 11 /02/2018 ACORO" CERTIFICATE OF LIABILITY INSURANCE `6ft� 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 have ADDITIONAL INSURED provisions or 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 970-482-7747 Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 CONTACT Karen E. Siwek, CPA NAME: PHONE 970-482-7747 FAX 970-484-4165 (A/C, No, Ext): (A/C, No): Fort Collins, CO 80525 Karen E. Siwek, CPA E-MAIL siwe co ora o.com ADDRE INSURERS AFFORDING COVERAGE NAIC # INSURER A: Westfield Insurance Company 24112 INSURED Wing Shack Enterprises, lnc. Edith Georgge INSURERB: 2990 West 29th Street, Unit A2 Greeley, CO 80631 INSURER C : INSURER D : INSURER E: INSURER F : Cr)VFROr;FS CFRTIFICATF NIIMRFR• RFVISION NIIMRFR- 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 TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CWP5054822 CWP8602741 11/15/2018 11/15/2018 11/15/2019 11/15/2019 EACH OCCURRENCE $ 1,000,000 PRAMIAGE ToRENTEDISES (E.occurrn 500,000 $ 5,000 MEDEXP (Any oneperson) PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PEC LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2>000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY NON-OWNED AUTOSPer ONLD CWP5054822 11/15/2018 11/15/2019 COMaBINdEDtSINGLE LIMIT $ 1,000,000 X BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY AMAGE accident $ A UMBRELLA LIAB EXCESS LAB OCCUR CLAIMS -MADE CWP5054822 11/15/2018 11/15/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED I X RETENTION $ 0 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE V❑ (Mandatory in NH) EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below N I A WCP5055634 11/15/2018 11/15/2019 SPR T T TE ORH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE -EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Dates: 5/16, 5/23, 5/30, 6/6, 6/13, 7/11, 7/18, 7/25, 8/1, 8/15, 8/22, 8/29, 915, 9/12, 9/19, 9/26 City of Fort Collins is included as additional insured per policy forms and conditions. CITYF11 City of Fort Collins P O Box 5080 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 Karen E. Siwek, CPA ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD