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HomeMy WebLinkAboutSS BLUE SKY LLC DBA THE HUMAN BEAN COFFEE TRUCK - INSURANCE CERTIFICATE (2)SSBLUES-01 VMATHIASON ACORO DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02/20/2018 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 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 endorsement(s). PRODUCER CONTACT NAME: PFS Insurance Group (A"r,"r o, E■t): (970) 635-9400 (FAX No :(970) 635-9401 4848 Thompson Parkway Suite 200 E-MAIL Johnstown, CO 80534 Aoo valeriem@mypfsinsurance.com INSURED SS Blue Sky, LLC dba Human Bean Coffee Truck LLC 3610 35th Ave Unit 9 Evans, CO 80620 Union Ins l�A\/CD A/�CC !`COTICIP`ATC All IAADCD. DC\/ICIrNKI A1111UFz1=P- 41 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 FX—] OCCUR CPA3124735-22 03/19/2018 03/19/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEDREMISES $ 300,000 MED EXP (Any oneperson) $ 1,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ P LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUOTOS ONLY CPA3124735-22 03/19/2018 03/19/2019 COMBINED SINGLE LIMIT ,de 1,000,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PeOacEcCe DAMAGE _ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPA3124735-22 03/19/2018 03M9/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ DIED I X I RETENTION $ 0 Aggregate 2,000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROP RIETOR/PXCLUDE/EXECUTIVE ❑ OFFICE .ry in NH) EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NSA 4189922 03/01/2018 03/01/2019 PER OTH- TA E.L. EACH ACCIDENT 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT 600,000 A Property CPA3124735-22 03/19/2018 03/19/2019 Limit 25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required Owner and Franchisee of drive through coffee stands. There are 6 drive through coffee stands and 1 storage faci ity. Loc 1-Coffee stand If required by written agreement, the certificate holder is included as additional insured for ongoing operations under general liability. CERTIFICATE HOLDER GANGtLLA I IUN City of Fort Collins 300 Laporte Ave. 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 pa"A "a 7/,.� ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD