Loading...
HomeMy WebLinkAboutNOCO FROZEN TREATS LLC - INSURANCE CERTIFICATE (4)KONAI-1 OP ID: KB ACORD CERTIFICATE OF LIABILITY INSURANCE 703114/2016 (MMIDDIYYYY) 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 CONTACT NAME: Michael T Ball Renaissance Insurance Group PHONE FAX P O Box 478 A/c No at): 970-674-8825 NC No): 970-674-8826 101 E Main Street E-MAJL Windsor, CO 80550 ADDRESS: mball@reninsurance.com Michael T Ball INSURERS AFFORDING COVERAGE NAIC # INSURER A: union Insurance Company 10804 INSURED Kona Ice of Northern Colorado INSURERS: Pinnacol Assurance NoCo Frozen Treats, LLC dba 5242 Silverwood Drive INSURERC: Johnstown, CO 80534 INSURERD: INSURER E : INSURER F : RnVFRA(:FR CFRTIFIrATF NIIMRFR• RFVI_SInN NI IMRFR- 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X CPA3124633-21 03/09/2016 03/09/2017 EACH OCCURRENCE $ 1,000,000. DAMAGE TO RENTEU- PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ECT LOC OTHER. GENERAL AGGREGATE $ 2,000,00 PRODUCTS -COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X X NON -OWNED HIRED AUTOS AUTOS X CPA3124633-21 03/09/2016 03/09/2017 COMBINEDiSINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE CPA3124633-21 03/09/2016 03/09/2017 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 $ DED I X I RETENTION $ 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4157362 07/01/2015 07/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500'00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Wording Subject to Policy Forms, Conditions, Definitions and Exclusions. Certificate Holder and Kites in the Park are Additional Insureds on the General Liability and Auto Liability per Written Contract. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Kites in the Park 215 N. Maston St., 3rd Floor AUTHORIZED REPRESENTATIVE {�, �. n Fort Collins, CO 80522 ��..I� � jluz © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD