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Home My WebLink AboutCONEJO AZUL DBA UNCLE JIMS DOGS - INSURANCE CERTIFICATEACORa►® CERTIFICATE OF LIABILITY INSURANCE `..► FOATE{MMroDMY1� 04/10/2017 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 NAME: NTAC dstansfield@farmersagent.com PHONE 970-204-0020 FAIL Ne : 970-204-0305 Stansfield Insurance Agency E-MAIL 5125 S College Ave, Suite B INSURERS AFFORDING COVERAGE NAIC # Fort Collins, CO 80525 INSURERA: Fanners Insurance Exchange 21562 INSURED INSURER B : INSURER C : Jim Lee INSURERD: 808 W. Mountain Ave INSURER E: Fort Collins, CO 80521 INSURER F : COVFRAGFS CFRTIFICATE 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 SUER POLICY NUMBER M LK:Y E F POLICYDt� LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occu . $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JE P LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGO $ $ A AUTOMOBILE LIABILITY ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS ONLY AUOTOS ONLY 185903877 11/18/2016 0$/1 $/2017 05/18/2017 11/18/2017 COMBINED SINGLE LlM1T Ea accident $ BODILY INJURY (Per person) $ 100,000 BODILY INJURY (Per accdent) $ 30Q,000 ParPROPER acddenDAMAGE $ 100,000 UMBRELLA LIAB EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A I STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE '— $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is additional insured with respect to automobile liability. 1997 Chevy Astro Van VIN#1 GNEL19W8VB227269 rt:oTiFIr ATF wn1 nFR CANCELLATION The City of Fort Collins Purchasing Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE f,.� Yi r U 1965-2015 AGUKU UUKf UKA 1 IUN. All ngnts reserve(7. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD