Loading...
HomeMy WebLinkAboutTUP2022-0222SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY GRAPEVINE 76051 200 S MAIN ST CITY OF GRAPEVINE CITY OF GRAPEVINE IS A NAMED ADDITIONAL INSURED ON THIS POLICY FOR GENERAL LIABILITY. 1,000,000 1,000,000 1,000,000 8 01/03/202301/03/20227013069340B 1,000,000 01/07/202301/07/20227013069290 88 A 2,000,000 2,000,000 1,000,000 10,000 1,000,000 1,000,000 01/07/202301/07/20227013069290YY 8 8 8 A 20508VALLEY FORGE INS CO 20443CONTINENTAL CAS CO 76051TXGRAPEVINE 2916 COLUMBINE DR YATYAS, LLC COI@jasonridleyagency.com (817) 281-4500 Paula Szymanski 76034TXColleyville 5303 Colleyville Blvd Ste A Jason Ridley Agency LLC 1/19/2022 City of Grapevine P.O. Box 95104 Grapevine, TX 76099 (817) 410-3165 Voice (817) 410-3012 Fax TEMPORARY USE PERMIT Issue Date: January 20, 2022 PROJECT DESCRIPTION: Covid Testing Site 1/20/22- 3/31/22 8am-5pm. at 1720 Cross Roads Drive PROJECT # TUP-22-0222 (817) 410-3010 Inspections www.mygov.us Permits LOCATION TENANT LEGAL 1701 Cross Roads Dr. Grapevine, TX 76051 Great Scott The Blk 2 Lot 2a Imp Only 1crossroads Of Dfw Addition CONTRACTOR Regional Airport, LP 2916 Columbine Drive Grapevine, TX 76051-0000 (817) 875-2148 Phone connerw34@gmail.com OWNER Carrabba's Italian Grill 7015 Snider Plaza #203 Dallas, TX 75205 INFORMATION Approved NOTICES Any and all tents, canopies, signs, banners, balloons, fences require separate permits; please contact building inspections for information 817-410-3165. Fire Lanes - No tents/merchandise are allowed to cross fire lanes. Any fencing shall be such that it can be moved by one person in the event of an emergency.All City of Grapevine codes and ordinances shall apply. MYGOV.US City of Grapevine | TEMPORARY USE PERMIT | TUP-22-0222 | Printed 01/20/22 at 10:38 a.m. Page 1 of 1