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HomeMy WebLinkAboutWING SHACK ENTERPRISES INC - INSURANCE CERTIFICATE (6)WINGS-6 OP ID: P5 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/16/2017 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 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 Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 CONTACT Karen E. Siwek, CPA NAME: A/CNNo Ext :970-482-7747 FAX No): 970-484-4165 E-MAIL ksiwek@bbcolorado.com Fort Collins, CO 80525 Karen E. Siwek, CPAADDRESS: INSURERS) AFFORDING COVERAGE NAIC M INSURER A: Westfield Insurance Company 24112 INSURED Wing Shack Enterprises, Inc. Edith George 2990 West 29th Street, Unit A2 INSURER B: INSURER c : Greeley, CO 80631 INSURER D : INSURER E INSURER F : 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 LTR TYPE OF INSURANCE ADDL BR WV POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE I,� OCCUR CWP5054822 11/15/2017 11115/2018 PREMISES Ea occurrence $ 500,000 A CWP5054822 11/15/2017 11115/2018 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN_ 'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC PRODUCTS -COMP/OPAGG $ 2,000,00 $ OTHER: A . AUTOMOBILE LIABILITY _ X ANY AUTO CWP5054822 11/15/2017 11/1W2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ _ HIRED AUTOS NON -OWNED AUTOS UMBRELLA LAB OCCUR EACH OCCURRENCE S 2,000,000 AGGREGATE $ 2,000,00 A EXCESS LAB HCLAIMS-MADE CWP5054822 11M5/2017 11M5/2018 DED I X RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN CP5055634 11/15/2017 11M5/2018 OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Taste of Fort Collins June 9th-11th City of Ft Collins and Townsquare Lifestyle Events are included as additional insured per policy forms and conditions. r:FRTIFIC:ATF FIOI nFR CANCELLATION CITYFT3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ft Collins ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 5080 AUTHORIZED REPRESENTATIVE FT Collins, CO 80524 Karen E. Siwek, CPA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD