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HomeMy WebLinkAboutCOOKIE MIKE LLC - INSURANCE CERTIFICATE (8)COOKI-1 OP ID: P6 ACORO� r ATE (MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 1011912017 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 CONTACT NAME: House Account Brown & Brown Inc PHONE 970-482-7747 a , No : 970-484-4165 4532 Boardwalk Dr, Suite 200 A/c No Ell: Fort Collins, CO 80525 E-MAIL ADDRESS: House Account INSURERS AFFORDING COVERAGE NAIC # INSURER A: American Casualty of Reading, 20427 INSURED Cookie Mike, LLC INSURER B : Property & Casualty Ins Co of 34690 123 N College Ave #106 INSURER C : Fort Collins, CO 80524-2489 INSURER D : INSURER E : INSURER F : rnX1P0A!_II f'FRTIF'ICATF NI IMRFR• RFVISInN NIiMRFR- 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. INPOLICY EFF POLICY EXP TRR TYPE OF INSURANCE I N SD DL WU/BDR� POLICY NUMBER MMI D/YYYY MM DDlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE T OCCUR 64024288877 11/17/2017 11/17/2018 PREM -PREMISES Ea occu ence $ 300,00 X MED EXP (Any one person) $ 10,00 Business Owners PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY ❑ PRO JECT LOC F1 PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ $ ALL OWNED SCHEDULED AUTOS AUTOS NO OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y-1 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 34WECIC8886 03/01/2017 03/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 600,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) P`rDTlrlf`ATC unl nt=o f'ANf'FI I ATIr)N CITYFC2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins PO Box 580 Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD