HomeMy WebLinkAboutEMPIRE CARPENTRY - INSURANCE CERTIFICATE (2)CERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company if selection box is not checked.
6000 American Pky Madison, Wisconsin 53783-0001
Insured's Name and Address Agent's Name, Address and Phone Number (Agt./Dist.)
Empire Carpentry Larry D. Peterson (970) 229-9393
Po Box 245 149 W Harvard Street Ste 102
Bellvue, CO 80512-0245 Ft. Collins, CO 80525-2186 (004/316)
This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder.
This certificate does not amend, extend or alter the coverage afforded by the policies listed below.
COYEiiAtE3
This is to certify that 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 terns, exclusions, and conditions of such policies.
TYPE OF INSURANCE
POLICY NUMBER
POLICY DATE
LIMITS OF LIABILITY
EFFECTIVE EXPIRATION
Mo Day, Yr(Mo. Day, Yr
Homeowners/
Bodily Injury and Property Damage
Mobilshomeowners Liability
Each occurrence $ 000
Boatowners Liability
Bodily Injury and Property Damage
Each Occurrence $ ,000
Personal Umbrella Liability
Bodily Injury and Property Damage
Each Occurrence $ ,000
Farm/Ranch Liability
Farm Liability & Personal Liability
Each Occurrence $ Ooo
Farm Employer's Liability
Each Occurrence $ 000
Workers Compensation and
Statutory ......,.,...
Each Accident $ 000
Employers Liability t
Disease - Each Employee $ '000
Disease - Policy Limit $ ,000
General Liability
General Aggregate $ 2,000 000
Products - CompletedOperationsA re ate $ 2,000 000
® Commercial General
LiabilitV(occurrence)
❑
❑
05-X 16943-14-00
10/30/2006
10/30/2007
Personal andAdvertisin Injury $ 1,000 -000
Each Occurrence $ 1,000 ,OoO
Damage to Premises Rented to You $ 100 000
Medical Expense (Any One Person) $ 5 000
Businessowners Liability
Each txcurrencett $ 000
Aggregatett $ ,000
Liquor Liability
Common Cause Limit $ ,000
Aggregate Limit $ ,000
Automobile Liability
❑ Any Auto
BodilyInjury Each Person
I ry $ 100 .000
® All Owned Autos
Bodily Injury - Each Accident $ 300 000
❑ Scheduled Autos
❑ Hired Auto
05-X90782-02-00
9/1/2006
9/1/2007
Property Damage $ 100 ,000
❑ Nonowned Autos
❑
Bodily Injury and Property Damage Combined $ '000
Excess Liability
❑ Commercial Blanket Excess
❑
Each Occurrence/Aggregate $ 000
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES / RESTRICTIONS / SPECIAL ITEMS t The individual or partners shown as insured ❑ Have ❑ Have not
elected to be covered as employees under this policy.
t t Products -Completed Operations aggregate is equal to each
occurrence limit and is included in policy aggregate.
CERTIFICATE HOLDER% IiIAME AN17 (I000I SS
CANCELLATION
• City of Fort Collins
Building & Zoning Dept
281 N College Ave
Fort Collins, CO 80524
Should any of the above described policies be cancelled before the
expiration date thereof, the company will endeavor to mail '( days)
written notice to the Certificate Holder named, but failure to mail such
notice shall impose no obligation or liability of any kind upon the
company, its agents or representatives. TO days unless different
number of days shown.
Fax: 224-6134
❑ This certifies coverage on the date of issue only. The above
described policies are subject to cancellation in conformity with their
terms and py the laws of the state of issue.
DATE ISSUED
AUTHORIZED REPRESENTATIVE
1/17/2007
Larry D Peterson
U-201 Ed. 5/00 Certificate Holder Stock No. 06668 Rev. 7/02