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ACOREI CERTIFICATE OF LIABILITY INSURANCE 6i2i2014YYY)
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 AGENCY IS CSR
NAME:
Beal & Winn Insurance Agency, LLC (A°No,Ext): (979)268-1500 FAX
No): (979)846-1979
1500 University Drive East E-MAIL
ADDRESS
Suite 101 INSURER(S)AFFORDING COVERAGE NAIC#
College Station TX 77840 INSURER :Colony Insurance Company
INSURED INSURER B General Star Indemnity Company
Foundation Lounge, LLC INSURER C:
DBA: Foundation Lounge INSURER D:
108 College Main INSURERE:
College Station TX 77840 INSURER F:
COVERAGES CERTIFICATE NUMBER:CL13112002376 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.
IN TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
LTR INSR WVD POLICY NUMBER (MMIDDIYYYY) IMM/DDIYYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LABILITY PRRENTED
PREMI EMISESS lEa occurrence) $ 100,000
A CLAIMS-MADE a OCCUR TXG327726 11/19/2013 11/19/2014 MED EXP(Any one person) _ $ 5,000
PERSONAL&ADV INJUR Y $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $ INCLUDED
Fl—1 POLICY JECT 171 LOC
AUTOMOBILE LIABILITY CO aBBIINdEDtSINGLE LIMIT(Ea
ANY AUTO BODILY INJURY(Per person) $
-
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
_ AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS _ AUTOS (Peracadentl $ _
UMBRELLA LIAB _ OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTION$ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITYY f N TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,descube under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
B Business Personal Prop IMA652831 11/19/201311/19/2014 Contents ACV1000Deductible 30,000
Business Income with EE 50,000
DESCRIPTION OF OPERATIONS)LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
CERTIFICATE HOLDER CANCELLATION
(979)764-34 96 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 College Station
1101 Texas Avenue
College Station, TX 77842 AUTHORIZED REPRESENTATIVE
Oren Beal, Jr-/CHARLI
ACORD 25(2010/05) ®1988-2010 ACORD CORPORATION. All rights reserved.
INS025(2D1005)DI The ACORD name and logo are registered marks of ACORD