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Home My WebLink AboutKLM ENTERTAINMENT LLC DBA REPICCI'S ITALIAN ICE & - INSURANCE CERTIFICATE (2)AC"RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/24/2019 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 end 0rsement(s). PRODUCER Liberty Mutual Insurance PO Box 1 Fairfield, OHH 45 45018 NAME: A/C No Ext : 800-962-7132 aPHONE c No): 800-845-3666 E-MAIL ADDRESS: BusinessService LibertMutual.com INSURERS AFFORDING COVERAGE NAIC # INSURERA: Ohio Security Insurance Company 24082 INSURED Klm Entertainment LLC DBA Repicci's Italian Ice & Gelato Of Northern Colorado INSURER B INSURERC: 765 Rodgers Cir Platteville CO 80651 INSURER0: INSURERE: INSURER F : 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. IN RI LTR TYPE OF INSURANCE A UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A �/ COMMERCIAL GENERAL LIABILITY ✓ BLS58024435 5/23/2019 5/23/2020 EACH OCCURRENCE $1 000,000 DAMAO RENTED PREMISES Ea occurrence $ 300,000 CLAIMS -MADE OCCUR MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ,000,000 $2,000,000 GEN'L ✓ POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY ✓ BAS58024435 6/30/2018 6/30/2019 IN LE LIMIT (Ea a accident) $ 1 OOO,OOO ANY AUTO BODILY INJURY (Per person) $ ✓ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS ✓ HIRED NON -OWNED AUTOS ONLY ✓ AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS -MADE AGGREGATE $ CEO RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER E.L. EACH ACCIDENT $ ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ Mandatory in NH) Iye (f s, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins, its directors, managers, sponsors, agents, and employees are listed as Additional Insured if required by written contract or written agreement subject to Auto Liability and General Liability Blanket Additional Insured Provision, per forms CA8810 and CG8810. -- — I,MIYV CLL/i 1 RAN City of Fort Collins 215 N Mason St 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 D Desirae Mohr (V 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 48300080 1 58024435 1 19-20 GL Master Certificate I Desirae Mohr 1 4/24/2019 4:34:18 PM (EDT) I Page 1 of 16