HomeMy WebLinkAboutTHE HUMAN BEAN - INSURANCE CERTIFICATE (4)SSBLUES-01
- E
CERTIFICATE OF LIABILITY INSURANCE
T I O
DATE (MM/DDIYYYY)
3/1912020
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)Tnust 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 endorsements .
PRODUCER
Insurance Group
P848 Thompson Parkway Suite 200
4
Johnstown, CO 80534
C NTACT
Ic°, No, Ertl (970) 635-9400 FAX No :(970) 635-9401
(AfFS
a
Affi6s, info mypf6insuranee.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A:Unlon.lnsurance Comparry
25844
INSURED
SS Blue Sky 2.0, LLC dba the Human Bean Coffee Truck; LLC
3610 35th Ave Unit 9
Evans, CO 80620
INSURER 8:Plnnacol. Assurance. Co
41190
INSURER C :
INSURER D :
INSURER E :
INSURERF:
ocincieUJ IJI IMRFQ-
VV-
THIS IS TO CERTIFY THAT THE. POLICIES OF INSURANCE LISTED BELOW HAVEBEEN 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
TypEOFINSURANCE
ADDLSUBR
POLICYNUMBER
POLICY EFF
POLICY EXP
_ -- _, .- -__ LIMITS
A
X
COMMERCIAL GENERA_LLIABICITY
CLAIMS -MADE OCCUR OCCUR
CPA312473.5-24
3/19/2020
3M12621
EACH OCCURRENCE.
$ 1,000,000
DR AGE:TO RENTED
$ 300,000
MED.EXP (Any.onePerson)
$ 10,000
PERSONAL &ADV.INJURY
$ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
X POLICY1:1 3EET LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMPIOP_AGG
$ 2,000,000
A
AUTOMOBILE LIABILITY
ANY AUTO
AUTOSDONLY AUTOSULED
qNp EDUL Ep
AUTOS ONLY X AUTOS ONLY
Ix
CPA3124735-24
3/19/2020
3/19/2021
EaaBidentl NGLE LIMIT
$ 11000,000
BODILY INJURY Per rson
BODILY INJURY Per accident
$
Pe�accd mOAMAGE
A
X
UMBRELLALIAB
EXCESS LU18
X
OCCUR
CLAIMS -MADE
CPA1124735-24
1
3/19/2020
3/19/120.21
1
EACH OCCURRENCE
$ 2000,000
AGGREGATE
$ 2,000,000
DED X RETENTION $ 0
- - --- -
- - - -
B
WORHERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNER/EXECUTIVE
W.F1 IMEM% R EXCLUDED? -
(Mantla[ary in NH)
If. yes, describe under
DESCRIPTION. OF OPERATIONS below.
NIA
4222176
3/1/2020
3/1/2021
_ _
PTR Tr __ ERH__
E.L. EACH ACCIDENT
1,000,000
$
-
E.L. DISEASE - EA EMPLOYEE
-$ 1 yOOO'OOO
I E.L. DISEASE - POLICYLIMIT
1,000,000
.$
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required)
City of Fort Collins Sales Tax Division
2nd Floor
216 North Mason Street
Fort Collins, CO 80524
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD CORPORATION. All rights reserved.
The ACORD narne and logo are registered marks of ACORD