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HomeMy WebLinkAboutAKG DBA ANDY'S PIPE DREAM - INSURANCE CERTIFICATE (2)AKGLLCD-01 S1CFISCHBACH CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 09/15/2017 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 NAMEO SRA Insurance Agency, LLC 5201 Johnson Drive, Suite 500 Mission, KS 66205 PHONE FAX (A/C, No, Ext): (913) 831-1777 A/C,No:(913) 831-4730 E-MAIL , info@srains.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: United Fire $ Casualty Co 13021 INSURED INSURER B : FirstComp Insurance Company 27626 INSURERC: AKG LLC DBA: Andy's Pipe Dream of The Rockies LLC INSURER D : 1849 A Chesapeake Cir Johnstown, CO 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 LTREFF TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY IDI YYY POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_X] OCCUR BINDER 09/20/2017 09/20/2018 EACH OCCURRENCE $ 1,000,000 DRAMIAGE TO ISES RENTED ccurren el $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY jpa7 LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUTOS ONLY BINDER 09/20/2017 09/20/2018 COMBINED SINGLE LIMIT (Ea aeddent)X $ 1,000,000 BODILY INJURY Per person)$ BODILY BODILY INJURY Per accident $ PeracEcCentDAMAGE $ A X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE BINDER 09/20/2017 09/20/2018 EACH OCCURRENCE 1,000,000 AGGREGATE $ 1,000,000 DED X RETENTION $ 10,600 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ FFICER/MEMBER EXCLUDED9 andatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA A MWC011684101 09/20/2017 09/20/2018 PER TE OTH- X I E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins PO Box 580 281 N. College Ave Ft Collins, CO 80522-0580 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