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HomeMy WebLinkAboutSH18-042 SUMMIT FOOD-Insurance 090118-090119AcaR"' CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 1-.....--''9/1/2019 8/30/2018 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(les) 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 Ileu of such endorsement(s). PRODUCER Lockton Companies 3280 Peachtree Road NE, Suite #250 Atlanta GA 30305 (404) 460-3600 GONTCT NAMEA H No Ext): FAX No EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A : Gemini Insurance Company 10833 INSURED Summit Food Service, LLC 1357140 1751 West County Road B, Suite 300 Roseville MN 55113 INSURER B: Sentry Casualty Company 28460 INSURER C : Sentry Insurance a Mutual Company 24988 INSURER D: INSURER E: INSURER F: rr)%1I:i rFRTIPIr®TF NIIIIVl R1=1/ICICIIJ NIIMi XXXXXXX 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y N 90-18840-06 9/1/2018 9/1/2019 EACH OCCURRENCE 1,000,000 DAMAGE ( RENTED 1,000,000 PREMISES Ea occurrence MED EXP (Any oneperson)5 OOO PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY PE C LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 1 $ C C A AUTOMOBILE X X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUTOS ONLY Drive Other N N 90-18840-04 (AOS) 90-18840-05 �MA) GVE100207901(1X1) 9/1/2018 9/1/2018 9/1/2018 9/1/2019 9/1/2019 9/1/2019 COMBINED SINGLE LIMIT Ea accident)$ 1,000,000 BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY Per accident $ XXXXXXX PROPERTY GE $ XXXXXXX Excess Limit $ 1,000,000 UMBRELLA LIAB EXCESS LAB OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX DED I I RETENTION $ $ C B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N 90-18840-01 90-18840-02 (Retro) 9/1/2018 9/1/2018 9/1/2019 9/1/2019 X STATUTE O R E.L. EACH ACCIDENT � $ 1,000,000 E,L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 C, Hired Auto Physical Damage N N 90-18840-04 (AOS) 9/1/2018 9/1/2019 $1,000 Comp/Collision DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Certificate Holder is included as an Additional insured as respects General Liability are required by written contract. 13483555 Kittitas County Jail 205 West Fifth Street Ellensburg WA 98926 ACORD 25 (2016/03) SEP a 6 2018 KITTITAS COUNTY SFIE;�ilFF= ACCOUNTING 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 ©1'988=20U ACORD CORPOKATION. All rights reserved The ACORD name and logo are registered marks of ACORD