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Home My WebLink AboutSEASONAL SOUPS & COMMON LINK - INSURANCE CERTIFICATE (2)Allstate. You're in good hands. Policy Number 648132338 SCHEDULE OF LOCATIONS Allstate Insurance Company Named Insured ANGELA NORMAN Effective Date: 01- 02 -17 12:01 A.M., Standard Time Agent Name OLD TOWN INS INC Loc. Bldg. Designated Locations Occupancy No. No. Address, City, State, Zip Code 001 001 8858 LONGS PEAK CIR, WINDSOR, CO 80550-2--76 OWN I DM CW 14 01 10 Allstate Insurance Company QAllstate, You're in good hands. 0 BU114R-3 Policy Number 648132338 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS Allstate Insurance Company Named Insured ANGELA NORMAN Effective Date: 01- 02 - 2 017 12:01 A.M., Standard Time Agent Name OLD TOWN INS INC Item 1. Business Description: FOOD TRUCK Item 2. Limits of Insurance Coverage Limit of Liability Aggregate Limits of Liability Products/Completed INCLUDED Operations Aggregate General Aggregate (other than $ 2,000,000 Products/Completed Operations) Coverage A - Bodily Injury and any one occurrence subject to Property Damage Liability $ 1,000,000 the Products/Completed Operations and General Aggregate Limits of Liability any one premises subject to the Damage To Premises Coverage A occurrence and the Rented To You $ 100,000 General Aggregate Limits of Liability Coverage B - Personal and any one person or organization Advertising Injury $ 11000,000 subject to the General Aggregate Liability Limits of Liability Coverage C - Medical Payments any one person subject to the Coverage A occurrence and the $ 5,000 General Aggregate Limits of Liability Item 3. Retroactive Date (Not Applicable in New York) Coverage A of this Insurance does not apply to "bodily injury" or "property damage" which occurs before the Retroactive Date, if any, shown here: (Enter Date or "None" it no Retroactive Date applies) Item 4. Form of Business and Location of Premises Forms of Business: LIMITED LIABILITY COMPANY Location of All Premises You Own, Rent or Occupy: See Schedule of Locations Item 5. Forms and Endorsements Form(s) and Endor ament(s) made a part of this policy at time of issue: See Schedule of Forms and Endorsements Item 6. Premiums Coverage Part Premium: $ 184.00 Other Premium: Total Premium: $ 184.00 THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. DL CW 22 01 10 Allstate Insurance Company WAllstate, You're in good hands. BU 114R-3 Policy Number 648132338 COMMERCIAL GENERAL LIABILITY COVERAGE SCHEDULE Allstate Insurance Company Named Insured ANGELA NORMAN Effective Date: 0 1 - 0 2 -17 12:01 A.M., Standard Time Agent Name OLD TOWN INS INC Item 5. Location of Premises Location of All Premises You Own, Rent or Occupy: See Schedule of Locations Code No. 49950 Premium Basis Flat Charge Premises/Operations Location ALL Exposure Premium Classification: Additional Insured _Rate $ 25.00 Products /Completed Operations Rate Premium Code No. 11168 Premium Basis Gross Sales Premises/Operations Location 0 01 / 001 Exposure $12 , 44 6 _ Rate i—_ Premium aassitication: 'ONCESSIONAIRES (PRODUCTS -COMPLETED PERATIONS ARE SUBJECT TO THE GENERAL AGGREGATE LIMIT) 9.725 r $ 159.00 MP Products/Completed Operations Rate Premium INCL Code No. Premium Basis Premises/Operations Location Exposure Rate Premium lassification: i Products/ Corn pleted Operations ate Premium i Code No. Premium Basis Premises/Operations Location Exposure Pate Premium Classification: Products/Completed Operations Rate Premium DL CW 12 01 10 Allstate Insurance Company Allstate, You're in good hands. POLICY NUMBER: 648132338 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): PARKS AND RECREATION CITY OF FORT COLLINS Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or 'personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. BU114R-3 CG 20 26 0413 C Insurance Services Office, Inc., 2012 Page 1 of 1