HomeMy WebLinkAboutWATER WORKS RON JENNIFER HENRICKSON - INSURANCE CERTIFICATE1
Insurance a Financial Services
® COUNTRY Mutual Insurance Company
❑ COUNTRY Casualty Insurance Company
P.O. Box 2100, Bloomington, IL 61702-2100
CERTIFICATE HOLDER
City of Fort Collins
281 N. College Ave
PO Box 580
Fort Collins, CO 80522-0580
CERTIFICATE OF INSURANCE
❑ CPP IRI BOP ❑ OTHER
Billing Number
0329521_T
Effective Date
07/19/2006
Insurance Office/Agent No.
5009/14211
Agent Larry Cain
Agent Phone 970-221-9655
INSURED'S NAME AND ADDRESS
Water Works Inc
c/o Ron & Jennifer Henrickson
PO Box 271128
Fort Collins, CO 80527-1128
The policies listed below have been issued to this named insured. Limits shown are the Policy limits in effect at the date of
this certificate. Claims paid anytime during the policy period may reduce some of these limits. This certificate is for information
only and does not amend. alter or extend anv coverage Drovided by Dolicies listed.
TYPE OF INSURANCE
POLICY NUMBER
POLICY EXPIRATION
LIMITS
DATE
GENERAL LIABILITY
® Commercial General Liability
AM6329650
07/19/2007
General Aggregate
$ 2,000,000
❑ Claims Made
Products Comp/Ops Aggregate
$ 2,000,000
❑ Occurrence
Personal & Advertising Injury
$ 1,000,000
❑ Owners & Contractors
Each Occurrence
$ 1,000,000
Protective
Fire Damage (Any One Fire)
$ 50,000
❑ Businessowners
Each Occurrence
$ 1,000,000
Medical Expense (Any One Person)
$ 5,000
AUTOMOBILE LIABILITY
Combined Single Limit
❑ Any Auto
Bodily Injury (Per Person)
$
® All Owned Autos
Bodily Injury (Per Accident)
$
❑ Scheduled Autos
Property Damage
$
❑ Hired Autos
❑ Non -Owned Autos
Combined Single Limit
$
Bodily Injury (Per Person)
$
GARAGE LIABILITY
Bodily Injury (Per Accident)
$
Property Damage
$
Garage Operations Aggregate
$
EXCESS LIABILITY
EACH OCCURRENCE
AGGREGATE
❑ Commercial Umbrella
$
$
❑ Other Than Umbrella
$
$
STATUTORY
WORKERS' COMPENSATION
$ (Each Accident)
AND EMPLOYERS LIABILITY
$ (Disease -Each Employee)
$ (Disease -Policy Limit)
OTHER
DESCRIPTIONS OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS
Should any o1 the above described policies be canceled before the expiration date thereof, the issuing 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 agencies or representatives.
Issued at: Fort Collins 09/20/2006
DATE HORIZED REPRESENTATIVE
91600a (01-03/01/04)