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HomeMy WebLinkAboutSS BLUE SKY LLC DBA THE HUMAN BEAN COFFEE TRUCK - INSURANCE CERTIFICATESSBLUES-01 VMATHIASON FACORO DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/8/2019 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 CONTACT NAME: PFS Insurance Group PHONE FAX 4848 Thompson Parkway Suite 200 (A/C, No, EXt): (970) 635-9400 (A/C, No):(970) 635-9401 Johnstown, CO 80534 ADDR'E : info@mypfsinsurance.com INSURER A: Union Insurance INSURED INSURERB:Acadla InSurana SS Blue Sky 2.0, LLC dba the Human Bean Coffee Truck, LLC INSURER C 3610 35th Ave Unit 9 INSURER D : _ Evans, CO 80620 rrnVGOArrGc rFRTIFIrATF NI IMRFR• RFVI.glnPJ NI IMRFR- 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 LTRA TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR CPA3124735-22 3/19/2019 3/19/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED REMI E Ea occurrence 300,000 $ MED EXP (Any oneperson) $ 1,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECT LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,600 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY CPA3124735-22 3/19/2019 3/19/2020 COMBINED SINGLE LIMIT 1,000,000 $ BODILY INJURY Perperson) _ $ $ BODILY INJURY Per accident PROPERTY DAMAGE er accident) $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPA3124735-22 3/19/2019 3/19/2020 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DIED I X RETENTION $ 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below N/A TBD 3/1/2019 3/1/2020 PER OTH- E.L. EACH ACCIDENT 500,000 $ E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more spies Is required) City of Fort Collins 215 North Mason Street 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 potA 0. ` ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD