HomeMy WebLinkAboutEMPIRE CARPENTRY - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE
American Family Insuranca Company ❑
American Family Mutual Insurance Company if selection box is not checked.
6000 American Pky Mad'isorl, Wisconsin 53783-omi
Agent's Name, Address and Phone Number (A9t/Dist.) Insured's Name and Address:
Larry D Peterson (004/316) Empire Carpentry LLC
149 W Harvard, Suite102 PO Box 245
Fort Collins„ CO W525 Bellvue, CO 80512-0245
970-229-9393
This WtiMcate Is Issued as a matter of information only and confers no rights upon the Gedificate Holder.
This certificate dam net amand- awned r altar fho remua.ewe etiwrda L .arm �u�r�� I:wJ L_r_.-.
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This is to certify that policies of insurance listed below have been Issued to the insured named above for the I y ✓andin^; :-g any
policy period indicated, notwithstanding
requirement, term or condition of any contract or other document with respect to which this certifloate may be issued or may pertain, the insurance afforded
by the policies described herein is sub'alt to all the terms exclusions, and conditions of such policies.
POLICY TYPE
TYPE OF INSURANCE
POLICY NUMBER
f
LIMITS OF LIABILITY
EffeOM
Expiration
- -
Mo Da Yr
MoMo Y
Homaowrtere/
Bodily Injury and Properly Damage
Mobil lehorlWeZIr9 Liabili
Each Occurrence
Boatownera Liability
00dlly Injury and Property Damage
Each Occurrence
Personal Umbrella Liability
Bodiy Injury and Property Damage
Each Occurrence
Farm/Ranch Liability
Farm & Personal LJabllity Each Occurrence
Farm Em ees Uabift Each Occurrence
Statutory ... .
Wotlpars CD111 pensation and
Each Accident
Employers Liability+
Disease - Each Employee
Disease - Policy Limit
0ansrai Liability
General Aggregate $ 2,000,000
® Commercial General
05-XI6943-14
10/30/2006
101M2007
Products - Completed Operations Aggregate $ 2,000,000
Liability (occurrence)
Personal and Advertising Injury $ 1.000.000
❑
Each Occurrence $ 1'04000
❑
Ora Damage (Any One Fire) $ 100 000
Medical One Person $ 5.000
Businessowners Liability
Each Occurrence + +
A re to + +
Automobile Liability
Bodily Injury - Each Person $100,000
®.Owned Autos (Basic form)
05-X90782-02
OW0112006
09/01/2007
Bodily Injury - Each Accident $300,000
❑ Owned Autos (Comp form)
Property Damage $100,000
❑ Hired Autos
Bodily Injury & Property Damage Combined
0 Non -owned Autos
❑� Garage liability
Excess Liability
❑ Commercial Blanket Excess
Each Occurrenea+Aggragate
DESCRIPTION OF OPERATIONSILOCATIONSNEHIChES/RESTRICTIONSISPECIAL ITEMS
+ The individual or partners shown as Insured "' elected to be
The City of Fort Collins Department of Purchasing in listed as an additional Insured.
cow red as employees under this policy.
++ Produds�Complaled Operations aggregate Is equal to each
Occurrence lint rd is included In Ica r eta.
ADOMONALINSURED
City of Fort Collins
Dept of Purchasing
PO Box 500
Fort Collins, CO 80522
Fax: 221-E707
Attn: John Stevens
Ed.1/96
® Should any of the above described policies be canceled before the
expiration date thereof, the company will endeavor to mail ^(10 days) written
notice to the certificate Holder named, but failure to mall such nonce shelf
Impose no cblt9ation or Viability of any kind upon the company. Its agents or
representatives. *10 days unless different number of days shown.
❑ This certifies coverage on the date of issue only. The above described
pobides are subject to cancellation in conformity with their terms and by the
10/09/2006
- Certificate Holder. COPIES to Servicas. Insured. Anent
Nn. r1RRRR