HomeMy WebLinkAboutTHE GOODNESS LLC - INSURANCE CERTIFICATE (4)--� THEGO-1 OP ID: RUTH
,d►coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
`� 1 11/03/2017
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 307-527-6929 CONTACT
AME CT Christopher A. Baustert
HBI Insurance Services, Inc. PHONE 307-527-6929 FAx 307-527-6950
2229 Big Horn Avenue (A/C, No, Ext): (A/C, No):
PO Box 1717 ADDRE :
Cody, WY 82414 ., .. .
INSURER A:Ohio Casualty Insurance Co. 119690
INSURED The Goodness, LLC INSURER B : Liberty Mutual Insurance Co. 123043
PO Box 72
LaPorte, CO 80535 INSURER C :
f+COTICl/"ATC \II IIIIIOCo• DM/ICIn K1 All IRARFD-
vTHIS 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
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITSITR '
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE [K OCCUR
X
BKS57643891
11/15/2017
11/15/2018
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED n
$ 300
MED EXP An one person)$
,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY u PRO LOC
JECT
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
B
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
X
BAS57643891
11/15/2017
11/15/2018
COMBINED SINGLE LIMIT (Ea accident)
$ 1,000,000
BODILY INJURY Perperson)
$
BODILY INJURY Per accident
$
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DE D RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, descibe under
DESCRIPTION OF OPERATIONS below
N / A
PER OTH-
TAT UTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE -POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CITY OF FORT COLLINS
215 NORTH MASON
FORT COLLINS, CO 80522
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 REDREVENTATIVE
Arnon -)e )nea/n�z�
n 919R8-2n15
The ACORD name and logo are registered marks of ACORD
CORIdRATION. All rights reserved