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Home My WebLink AboutPIPERS GREASE MONKEY INC - INSURANCE CERTIFICATE (5)A b® CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) 06/16/6/16/2017 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 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT NAME: CLIENT CONTACT CENTER PHONE FAX C.IC, No, o Ext : 888-333-4949 A/C No): 507-446-4664 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 317-254-1 INSURER B: PIPERS GREASE MONKEY INC INSURER C: 6318 CATTAIL CT INSURER D: FORT COLLINS, CO 80525-9174 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER: 0 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDDIYYYY LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR BUSINESS OWNER'S LIABILITY Y N 9190781 08/06/2017 08/06/2018 EACH OCCURRENCE $1,000,000 PREMISES Ea occurrence)DAMAGE TO RENTED $100,000 X MED EXP (Any one person) GEN'L �OTHER: PERSONAL & ADV INJURY $1 ,000,000 AGGREGATE LIMIT APPLIES PER: POLICY [IJECT F LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOP AGO $2,000,000 A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY X NON -OWNED AUTOS ONLY N N 9190782 08/06/2017 08/06/2018 COMBINED SINGLE LIMIT Ea accident $1 000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA I N 0733348 1 08/06/2017 08/06/2018 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYEE $100,000 E.L DISEASE -POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) CITY OF FORT COLLINS IS LISTED AS ADDITIONAL INSURED ON BUSINESSOWNERS LIABILITY. CERTIFICATE HOLDER CANCELLATION 317-254-1 CITY OF FORT COLLINS 215 N MASON ST FORT COLLINS, CO 80524-4402 10 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 Cd 19RR-2015 ACORD CORPORATION. All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD