HomeMy WebLinkAboutSILVER GRILL - INSURANCE CERTIFICATEACC) d CERTIFICATE OF LIABILITY INSURANCE
DATE4/03M 2/0 n
ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
THIS CERTIFICATEIS
NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
CERTIRCATE DOES
OF INSURANCE DOESOT NCONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
BELOW. THIS CERTIFICATE
REPRESENTATIVE OR ANDTHE CERTIFICATE HOLDER.
-PRODUCER,
IMPORTANT: B the oerbficate holder is an INSURED, the poiioy(iea) Must ADDITIONAL INSURED provisions or be endorsed:
If SUBROGATION IS WANED, subject to the terms and Conditions of the policy, certain policies may require an endorsement A statement on.
this certificate does not confer rights tothe certificate holder in lieu of such endomement(a).
PRODUCER —_ -
NAME:=-__Bf18I111BD8IlielSOn, CISR -
PHONE (970) 288 71EXIM,18
(970) RPM
Flood and Peterson
aooREss BDanielson®FloodPeteison.com
Corporate Mailing Address:
INSURER pFFOR%111,: VERAGE.._
NAIL!
P.O. BO%'578 - -
INsuRERA: EMCASCOInsurenaeCompany
2141.5 _
Greeley CO 80632
INSuaEo
INSURERS:-- Employere Mutual Casualty Company
21415
_ .__
INSURER C c Fmnacol Assurance
41190
Amass, Inc. dba Silver Grill. - - -
INSURER D : -
218 Walnut Street
INSURER E •
- -
INSURER F: - — -------
Fort Collins - _- CO 80524
COVERAGES
THIS IS TO CERTIFY THAT THE.POLICIES.OF INSURANCE LISTED BELOW HAVE. BEEN ISSUEDTU IHE,INSURED NAMED. ABOVE FOR THE POLICY PERIOD
INDICATED.. NOTWITHSTANDING ANV REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T-1S'-
CERTIFICATEMAYBE ISSUED ORMAY PEFiTA1N, THE INSURANCE AFWRDEOBY THEPOLICIES DESCRIBED HEREIN IS SUBJECT MALL THE�TERMS,:
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
_ _
.
LTR
A
-
B
_._ TWEOF INSURANCE I
MERCIALGENERALLIABrIT/ -
CLAIMS -MADE ®OCCUR
-
_P.OLICY NUMBER
_ .... . _
- -
-85
6E0.22-21
04/Ot/2020--
04/01/2020
-
MIO _..__
- 04/01/2021--
-
04/01/2021
- .LINKS'.
EACHOCCURRENCE_'
-
$ 1,000,000_500
PREMISES EH do 1--
000
$--9-'MEDE%P
: 10,000
- PERSONALAADVIN1uRY_-'
&AD
..-11000,000_600-22-85-21.
TGERLAGGRE&Tt
.GENERALAGOREGATE -_
$ 2'�'�.PRO-
UMK APPLIES PER:
LOC _-PRODUCTS-COMPIOP
-..
AUTOMOBILE LIABILITY,.
. ._ .-
.ANY AUTO. _
-- SCHEDULED
OWNED
- AUTOSONLY.' AUTOS -
HIRED NON -OWNED
AUTOS ONLY - AUTOS ONLY
AGG
$ 2,000000ICY❑JECT®2,000,000ER
..
COMBINED SINGLE UMII --
EaeaMe -..
$ 1-.,000,000 -c
BODILY INJURY(Per Person)
-
$'
BODILvhaiuiavreerecdaem)
-PROPE
$ :
DAMAGE -.
Per a -
- - --
$ - -
Medical Payments -
If 5,000.
B
-
C
UMBRELLA LIB....
EXCFSSLULB---
-
OCCUR ..
CLAIMS -MADE
HiA.
-
-.
6J0-22-85-21
:_. _.
4058092
- - -' -
04/01/2020
07/01/2019
..
04/01/2021
,.
- - - -X
07/01/2020
_
EACH OCCURRENCE ..
$ 2.0001000
AGGREGATE-
2,000,000..
__:
PER OTH-
STA ER'
--- -
- -
'
DED. RETENTION$
WORKERS COMPENSATION -
AND EMPLOYERS' LIABILnY Y / N
ANY PRO PRIETORIPARTNER(ExECUTNE
(MandaRIMEMBER IXCWQlD7 -' _ Y
(Mandatary In NN) � "-
If Yea: aesaibe under.___ ..
DESCRIPTION OF OPERATIONS WOW
E.L. EACH ACCIDENT
$ '�
ELL DISEASE - EA EMPLOYEE
500,OD0
S
EL DISEASE -POLICY LIMIT
500,000 -
S '
DESCRIPTION OF.oPENATIONs i LOCATIONS/ VEHICLES (ACORD 101, Additlanel Remerke 8ctietlulq may be aaachad if more epees is,requlrad) -
City of Fort Collins is Included. as Additional Insured as required by written contract with respects to liabilityarising out of a portabla sign at the premise.. -
- - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
- - - - - - - - - THE EXPIRATION DATE THEREOF, fiditili-WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS. -
City of Fort Collins
RO. Box 580 AUTHORIZED REPRESENTATIVE -
Fort Collins CO 80522.0580 On/a.(wn .
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