HomeMy WebLinkAboutCOOKIE MIKE LLC - INSURANCE CERTIFICATE (7)COOKI-1 OP ID: P6
ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
�i 02/28/2018
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 Al
House Account _
Brown & Brown Inc PHONE 970 482-7747 jaC No): 970-484-4165
4532 Boardwalk Dr, Suite 200 (a/c. No. Ertl:
Fort Collins, CO 80525 ADDRIESS:
House Account
INSURED Cookie Mike, LLC
123 N College Ave #106
Fort Collins, CO 80524-2489
INSURER A:Transportation Insurance Co. 20494
INSURER B : Property & Casualty Ins Co of 34690
INSURER C :
INSURER E .
INSURER F :
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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.
INSIRTR
TYPE OF INSURANCE
A L
INSD
UBR
WVD
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 XOCCUR
64024288877
11/17/2017
11/17/2018
pREM SESTO
Ea occur ante
$ 300,00
X
Business Owners
MED EXP (Any one person)
$ 10,00
PERSONAL & ADV INJURY
$ 1,000,00
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,00
PRODUCTS - COMP/OPAGG
$ 2,000,00
POLICY 71 JECT PRO ❑ LOC
OTHER:
AUTOMOBILE LIABILITY
(Ea acccidentSINGLE LIMIT
$
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$ .
EXCESS LIAB
CLAIMS MADE
DED RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
N / A
34WECIC8886 03/01/2018 03/01/2019
PER OTH-
T STATUTE ER
$ 100,00
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
$ _ 100,000
E.L. DISEASE - POLICY LIMIT
If yes, describe under
DESCRIPTION OF OPERATIONS below
$ 500,00
PROPERTY 229,73
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER %1AI14%1 fiI IVI.
CITYFC2
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
PO Box 580 AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80524
V Ty68-LV 14 MI..V RU l'VRn-V R/111vn. ru nynw ,cat, vcu.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD