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HomeMy WebLinkAboutSS BLUE SKY LLC DBA THE HUMAN BEAN - INSURANCE CERTIFICATE (3)�.---, SSBLUES-01 SFERRIS ACORO ` DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/7/2019 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 AME CT Stella Ferris PFS Insurance Group PHONE Ext): (970) 635-9400 FAX (970 635-9401 4848 Thompson Parkway Suite 200 EMAIL (A/C, No): ) Johnstown, CO 80534 ADDRESS: stellaf@Typfsinsurance.com INRIIRFRISI AFFORDING COVERAGE NAIL # INSURED INSURER B: Acadia Insurance Company SS Blue Sky, LLC dba Human Bean Coffee Truck LLC INSURERC: 3610 35th Ave Unit 9 INSURER D. Evans, CO 80620 INSURER E INSURER F : T�r�r wT� w uao�o. RGVICIf1kl Ali IMRFR- vv v -- 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. INS ADDL SUBR TYPE OF INSURANCE p POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [X� OCCUR CPA3124735-22 3/19/2019 3/19/2020 DAMAGE TO RENTED PREMISESJEa ormirrencel MED EXP An one person)$ 300,000 _ 1,000 $ 1,000,000 PERSONAL & ADV INJURY AGGREGATE LIMIT APPLIES PER: _ PRO- -� POLICY � JECT I LOC GEN'L X GENERAL AGGREGATE $ 2,000,000 2,000,000 $ PRODUCTS -COMP/OP AGG $ OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident) 1,000,000 $ X ANY AUTO CPA3124735-22 3/19/2019 3M9/2020 BODILY INJURY Perperson) BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X X AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident ( cc -- $ $ A X UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS -MADE CPA3124735-22 3/19/2019 3/19/2020 EACH OCCURRENCE _ $ 2,000,000 AGGREGATE $ 2,000,000 DIED X RETENTION $ 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? ER/MEMBER in NH) N / A TBD 3/1/2019 3/1/2020 PTATUT ERH E.L. EACH ACCIDENT__ 500,000 $ _ E.L. DISEASE - EA EMPLOYEE 500,000 $ E.L. DISEASE - POLICY LIMIT 500,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD