HomeMy WebLinkAboutTHE KITCHEN CAFE LLC - INSURANCE CERTIFICATE, 1%. R CERTIFICATE OF LIABILITY INSURANCE FDATE /2019 /YYYY)
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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 CONTACT
Marsh USA Inc. NAME:
333 South 7th Street, Suite 1400 PHONE FAX_WCc No Ext1:
Minneapolis, MN 55402-2400 ADDRESS:
Attn: Minneapolis.CertRequest@marsh.com Fax 212-948-0114-------
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Zurich American Insurance Company 16535
INSURED The Kitchen Cafe LLC INSURER B : American Guarantee and Liability Insurance Company 26247
P O. Box 2250 INSURER C :
1601 Pearl Street, Suite 200 INSURER D
Boulder, CO 80302 - --
INSURER E
INSURER F
COVERAGES CFRTIFICATF NI IMRFR- C.HI-0mAm7m_no DCVICIn AI su IIIA000-
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 SUM OF INSURANCE ADDL SUPOLICY EFF POLICY EXP
LTR POLICY NUMBER MM/DDlYYYY) (MMIDDIYYYYJ LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE lxl OCCUR
GLA 0507689-01
03/01/2019
03/01/2020
EACH OCCURRENCE
$ 1,000,000
DAMAGE T RENTED
PREMISES Ea occurrence
$ 3,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER,
POLICY PE� [�] LOC
GENERAL AGGREGATE
$ 3,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER
A
AUTOMOBILE
LIABILITY
GLA050768901
03/01/2019
03/01/2020
COMBINED SINGLE LIMIT
Ea accident
$ 1,000.000
X
BODILY INJURY (Per person)
_
$
ANY AUTO
X
OWNED SCHEDULED AUTOS ONLY AUTOS
BODILY INJURY Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
X
PROPERTY DAMAGE
Per accident
$
$
X
UMBRELLA LIAR
X
OCCUR
AUC 0534407-01
03/01/2019
03/0112020
EACH OCCURRENCE
$ 5,000,000
LLEXCESS
AGGREGATE
$ 5,000,000
LIAB
CLAIMS -MADE
D RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICE RIM EMBER EXCLUDED9 �
N/A
WC0507688-01
03/01/2020
X IPER OTH-
STATUTE I I ER
E.LEACHACCIDENT
$ 1,000,000
E L DISEASE - EA EMPLOYEE
$ 1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
—
E L DISEASE - POLICY LIMIT
$ 1,000,000
A
Liquor Liability
GLA 0507689-01
03/01/2019
03/01/2020
Each Common Cause.
1,000,000
Aggregate
2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
VCR I iri%,A I C IIVLUCi( GANUtLLA I IUN
City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
215 N Mason Street, 1st Floor THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
South Wing P.O. Box 580 ACCORDANCE WITH THE POLICY PROVISIONS.
FL, Collins, CO 80522-0580
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Masashi Mukherjee �R.p.oe,► : . }iQ �a Lc,.+n�+ t�
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD