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HomeMy WebLinkAboutSS BLUE SKY LLC DBA THE HUMAN BEAN - INSURANCE CERTIFICATE (5)^� SSBLUES-01 VMATHIAS .acoRo CERTIFICATE OF LIABILITY INSURANCE DATE 02/20/2018 ) �.� ozr2o/2o1 a 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 riqhts to the certificate holder in lieu of such endorsement(s). PRODUCER PFS Insurance Group 4848 Thompson Parkway Suite 200 Johnstown, CO 80534 INSURED ieuc: No. an: (970) 635-9400 1 W8. N01(970) 635-9401 I SS Blue Sky, LLC dba The Human Bean 3610 35th Ave Unit 9 Evans, CO 80620 INSURERC: INSURER D INSURER E INSURER F : nion Insurance Corn 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 LTRA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE LX OCCUR CPA3124735-22 03/19/2018 03/19/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE ES(Ea NTED ccur_en e $ 300,000 $ 1,000 MED EXP (Any oneperson) PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ JE [_] LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -AWNED AUTOS ONLY AUTOS ONLY CPA3124735-22 03/19/2018 03/19/2019 COMBINED SINGLE LIMIT (EaX $ 1,000,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident $ $ PROPERTY DAMAGE Per accident A J.X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPA3124735-22 03/19/2018 03/19/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ DIED I X I RETENTION $ 0 Aggregate 2,0000000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE O FACE. ory in NH) XC! ;1DEM (Mandatory in NFI) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4189922 03/01/2018 03/01/2019 PTA ER T ORH E.L. EACH ACCIDENT 500,000 $ E.L. DISEASE - EA EMPLOYEE 500,000 $ E.L. DISEASE - POLICY LIMIT 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) l9G11 C 109 -1 E1IF—Ill I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ACCORDANCE WITH THE POLICY PROVISIONS. 215 North Mason St. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD