Loading...
HomeMy WebLinkAbout593124 HILLCREST SHOPS DBA SEAN & MELISSA BAUTISTA - INSURANCE CERTIFICATE------ "i HILLSHO-01 LSAUBERT ,acoRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/16/2019 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 endorsement(s). PRODUCER License # 0504756 CONTACT Lori Saubert NAME: Kingsburg Insurance Agency PHONE FAX P.O. Box 100 (A/C, No, Ext): (559) 897-5811 (A/C, No):(559) 896-0829 Kingsburg, CA 93631 E-MAIL-ADESS. INSURED Hillcrest Shops dba Sean & Melissa Bautista 6943 S. Reed Reedley„ CA 93654 E: F: Insurance Fund CnVFRAGFR CFRTIFICATF NI IMRFR- RFVIRIr1N NI IMRFR- 35076 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 INSD SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS TR MM/ /YYYY MM/ A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X CA000012270-11 12/18/2017 12/18/2018 EACH OCCURRENCE ! $ 1'000'000 DAMAGE TO RENTED PREMl occurrence) 50,000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER PRO- POLICY JECT _ LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS_- COMP/OP AGG 2,000,000 $ $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ HIRED NON- MED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A 9098212-19 5/1I2019 5/1/202Q PER OTH- TAT TE R E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1'000'D00 If yes, describe under DESCRIPTION OF OPERATIONS below 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: Certificate holder is named as additional insured per GL forms CG 20 10 04 13 & CG 20 37 04 13 attached and Auto form 1198 (01104) attached but only in regards to work completed by named insured for railroad amusement equipment work / 30 days notice of cancellation - 10 days for non payment of premium City of Fort Collins Attn: Marisa Donegon P.O. Box 580 Fort Collins, CO 80522 L;ANUtLLA 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD