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HomeMy WebLinkAboutSS BLUE SKY LLC DBA THE HUMAN BEAN COFFEE TRUCK LL - INSURANCE CERTIFICATESSBLUES-01 LJOHNSON AcoRO CERTIFICATE OF LIABILITY INSURANCE FD 02 23/2017Y) 02/23/2017 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 endorsement(s). PRODUCER CONTACT NAME: PFS Insurance Group PHONE 4848 Thompson Parkway Suite 200 (A/C, No, Ext): (970 l FAX ) 635-9400 (A/C, No):(970) 635-9401 E-MA'L�_ info m fsinsurance.com ADDRESS Johnstown, CO 80534 .@ yp__-__-- _ INSURED INSUREFJS) AFFORDING COVERAGE INSURER A . C.Ontlnentai Western Group _ SS Blue Sky, LLC dba Human Bean Coffee Truck LLC I INSURERc:_ 3610 35th Ave Unit 9 [IINNS" RER":Evans, CO 80620SURER E INSURER F rnVGcnn=Q CF0TIGICATG NI IMRGD• RFVISInN NI IMRFR• 1 NAIC 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. 'NT R TYPE OF INSURANCE AtDDDL'ISUBIR POLICY NUMBER POLICY EFF POLICY EXP LIMITS WV MMIDD/YYYY MM! DlYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR _ CPA3124735-21 03/19/2017 03/19/2018 300,000 DAMAGE TO RENTED PREMISES (Ea occurrence)$ _ MED EXP (Anyoneperson) $ 1,000 ---- — PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 2,000,000 $- 20000,000 GEN'L AGGREGATE LIMITAPPLIES PER: POLICY PEST LOC OTHER $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) -- - _. -_ -$ _ X ANY AUTO CPA3124735-21 03/19/2017 0 1/19/2018 BODILY INJURY (Per person) OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE _ $ 2,000,000 EXCESS LIAB CLAIMS -MADE CPA3124735-21 03/19/2017 03/19/2018 AGGREGATE $ DED RETENTION $ Aggregate 4,000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE �� FFICER/MEMBER EXCLUDED? �iAandatorym NH) N / A 189922 03/01/2017 03/01/2018 i STATUT _ ORH_ E.L_EACH,ACCIDENT _ $ 500,000 500,000 E.L. DISEASE - EA EMPLOYEE; $ If yes, describe under DESCRIPTION OF OPERATIONS below _ _ r,0D 000 I E.L. DISEASE - POLICY LIMIT $ A Property CPA3124735-21 03/19/2017 03/19/2018 Limit I 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Owner and Franchisee of drive through coffee stands. There are 6 drive through coffee stands and 1 storage facility. Loc 1-Coffee stand City of Fort Collins 300 Laporte Ave. Fort Collins, CO 80521 Lh_1CLha1111AG\Lei 01 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 REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD