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HomeMy WebLinkAboutTHE GOODNESS LLC - INSURANCE CERTIFICATE (3)GOODNA OP ID: H2 ACORO- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/28/2016 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 Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 House Account CONTACT House Account NAME: _ M No. E, I:970-482-7747 ac No): 970-484-4165 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Westfield Insurance Company 24112 INSURED The Goodness, LLC 3519 Patterson Court Fort Collins, CO 80526 INSURER B : INsuRERc: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 UBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE 111 OCCUR X CWP0375910 04/22/2016 04/22/2017 DAMAGE TO RENTED PREMISES 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 PRO- POLICY 7JECT LOC PRODUCTS - COMP/OPAGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1 000 00 , , BODILY INJURY (Per person) $ A ANY AUTO CWP0375910 04/22/2016 04/22/2017 ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB j OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE I ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ A Property Section CWP0375910 04/22/2016 04/22/2017 A Equipment Floate CWP0375910 04/22/2015 i 04/22/2016 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as additional insured regarding commercial general liability per CG2012 FAX: 970-221-6782 CERTIFICATE HOLDER CANCELLATION CITYF10 City of Fort Collins 215 N. Mason St. Fort Collins, CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE House Account ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INSURANCE AGENCY: BROWN & BROWN OF COLORADO INC 4532 BOARDWALK DR STE 200 FORT COLLINS CO 80525-3628 NAMED INSURED: THE GOODNESS LLC 3519 PATTERSON CT FORT COLLINS CO 80526 AGENCY PHONE # 970-482-7747 DATE OF MEMO: 02/28/16 CITY OF FT COLLINS 215 N MASON FT COLLINS CO 80521 POLICY NO.: CWP 0375910 POLICY TERM: 04/22/16 - 04/22/17 COMPANY: WESTFIELD INSURANCE COMPANY RE: EVIDENCE OF INSURANCE -- ADDITIONAL INSURED NOTICE YOU ARE SHOWN AS AN ADDITIONAL INSURED ON THE POLICY SHOWN ABOVE AND THE GENERAL LIABILITY LIMITS ARE DISPLAYED BELOW. THIS NOTICE IS EVIDENCE THAT INSURANCE HAS BEEN ISSUED TO THE NAMED INSURED(S). WE HAVE DISPLAYED BELOW THE NECESSARY INFORMATION FOR YOU. IF YOU DESIRE ANY ADDITIONAL INFORMATION PLEASE CONTACT THE AGENCY SHOWN ABOVE AND THEY WILL SECURE IT FOR YOU FROM WESTFIELD INSURANCE. POLICY LIMITS: GENERAL AGGREGATE LIMIT OTHER THAN PRODUCTS/COMPLETED OPERATIONS) 2,000,000 PRODUCTS/COMPLETED OPERA IONS AGGREGATE LIMI,I 2,000,000 PERSONAL & ADVERTISING INJURY LIMIT (PER PERSON OR ORGANIZATION) 1,000,000 EACH OCCURRENCE LIMIT 1 000,000 DAMAGE TO PREMISES RENTED TO YOU LIMIT (ANY ONE PREMISES) �100,000 MEDICAL EXPENSE LIMIT (ANY ONE PERSON) $5,000 Ohio Farmers Insurance Company Westfield Insurance Company Westfield National Insurance Company American Select Insurance Company Old Guard Insurance Company P.O. Box 5001 One Park Circle Westfield Center OH 44251-5001 AD 8052 (12-09)