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Home My WebLink AboutDAVID KIRCHHOFF - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID CS DATE(MWDDM ) KIRCH-3 09 06 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GIA Group/Glenwood Ins. Agency HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P 0 Box 1270 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Glenwood Springs CO 81602-1270 Phone:970-945-9161 Fax:970-945-6027 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA The Hartford INSURER B David Kirchhoff & Lynn INSURERC 1620 Tiburon Blvd INSURER Tiburon CA 94920 rnvFRArFA 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYYB PDATEMM/DDIYTN LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2 r 000 , 000 PREMISES (Ed occurence) $300,000 A X COMMERCIAL GENERAL LIABILITY 34SBARV8931 09/01/07 09/01/08 MED EXP(Any one person) $10,000 CLAIMS MADE OCCUR PERSONAL& ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $4,000,000 POLICY PECTRO- LOC J AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON OWNED AUTOS PROPERTY DAMAGE (Per accident) S GAR AGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY AGE, EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ A OCCUR CLAIMSMADE 34SBARV8931 09/01/07 09/01/08 AGGREGATE $ $ DEDUCTIBLE $ X RETENTION $10,000 WORKERS COMPENSATION AND TORV LIMITS ER EMPLOYERS' LIABILITY E L EACH ACCIDENT $ ANY PROPRIETOWPARTNERIEXECUTIVE EL DISEASE - EA EMPLOYEE $ OFFICER/MEMSER EXCLUDED' If as describe under SPECIAL PROVISIONS below EL DISEASE - POLIGV LIMIT $ OTHER A Property Section 34SBARV8931 09/01/07 09/01/ 88 DESCRIPTION OF OPERATIONS I LOCATIONS [VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate holder is named as additional insured. CFRTIFICATE 1-101_DER CANCELLATION City of Fort Collins P.O. Box 580 Fort Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI, DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 25 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) 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) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon