HomeMy WebLinkAboutDAWSON'S FINE JEWELRY - INSURANCE CERTIFICATEDATE (MMIDD/YYYY)
ACCRL3 CERTIFICATE OF LIABILITY INSURANCE 01/19/2016
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), AUTHOR,ZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 ONTACT Andrew Burton
Mountain States Insurance Marketing PHONE
A/c, No Extk719-685-1701 _ Arc No):
P.O. Box 391 E-MAIL
Manitou Springs CO 80829 ADDRESS:
INSI IRFR/SI AFFORDING COVERAGE NAIC
Mutual Insurance Company
INSURED Dawson's Fine Jewelry INSURERB:
151 W. Oak St. INSURER C : _
rO i Collins, CO. 80524-7106 INSURERD_ —
INSURER E :
INSURER F :
RF\/ICI(1M NI IMRFR•
I.UVCR/iVCJ
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�ADDL SUER POLICY EFF POLICY EXP
LTRT TYPE OF INSURANCE V4Vn POLICY NUMBER MM/DDVYYYY MM/DDTYYY LIMITS
✓ COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence
$ 300,000
MED EXP (Any one person)
$ 5,000
PERSONALBADVINJURY
A
55-009655
08/01/2016
08/01/2016
$ 1,000,000
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PRO- LOC
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ Z,000,OOO
— —
OTHER:
AUTOMOBILE LIABILITY
Ea acoldeDtSINGLE LIMIT
$
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$ _
i
AGGREGATE
$
EXCESS LiAs CLAIMS -MADE
DED ]71RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
ER
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N / A
E.L. DISEASE - POLICY LIMIT
1 $
If yes, describe under
DESCRIPTION OF OPERATIONS below
EDE]
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: Sidewalk Sign in Front of Store
CERTIFICATE HULUtK l,N1YVCLLM 11W11
City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Attn: Rhonda Henson THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
281 N. College Ave.
P.O. Box 580 AUTHORIZED REPRESENTATIVE
Fort Collins, Co. 80522-0580
V 'I!J2SS-ZUl4 AL;UKU L UKrUKA I IUR. K!I rI9I115 ft!5eFV'BU,
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
Produced using Forms Boss Web software. www.FormsBoss.com; ? Impressive Publishing 800-208-1977