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HomeMy WebLinkAboutNOCO FROZEN TREATS LLC - INSURANCE CERTIFICATE (3)----� KONAI-1 OP ID: KB .44cORO DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/14/2016 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), AUTHORIZED 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 CONTANAME: CT Michael T Ball _ Renaissance Insurance Group PHONE FAX P O Box 478(A/C.No Ell: 970-674-8825 AC,No): 970-674-8826 101 E Main Street ADDRESS: Windsor, CO 80550 SS: mball@reninsurance.com Michael T Ball INSURERS AFFORDING COVERAGE NAIC # INSURER A: Union Insurance Company 10804 INSURED Kona Ice of Northern Colorado INSURERB: Plnnacol Assurance NoCo Frozen Treats, LLC dba 5242 Silverwood Drive INSURER C Johnstown, CO 80534 INSURER D INSURER E INSURER F : rnVFRAr:FR CERTIFICATE NIIMRFR• RFVIRION NIIMRFR-- 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 TYPE OF INSURANCE DDL U POLICY NUMBER MMIDD/YYYY MM DDlYYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE Al OCCUR X CPA3124633-21 03/09/2016 03l09/2017 PAMAGE TO REMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO- JECT FX] LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00( BODILY INJURY (Per person) $ A X ANY AUTO CPA3124633-21 03/09/2016 03/09/2017 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident - $ X X NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 A EXCESS LIAB CLAIMS -MADE CPA3124633-21 03/09/2016 03/09/2017 DED I X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 4157352 07/01/2015 07/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A _ - -- --- $ 100,00 E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT 50� �� $ , DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Wording Sub1'ect to Policy Forms, Conditions, Definitions and Exclusions. Certificate Holder is an Additional Insured Regarding the General Liability and per Written Contract. CFRTIFIrATF I-In1 r1FR CANCFI I ATIAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins 215 Mason St., 2nd Floor AUTHORIZED REPRESENTATIVE Fort Collins, CO 80524 s�.Q.�1Gutd�eti,�cas✓t.�r-c.L © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD