HomeMy WebLinkAboutROBERT V EWING - INSURANCE CERTIFICATECERTIFICATE 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 (AgL/Dist.)
Robert V Ewing Kathy A. Collins (970) 225-6866
650 Redstone Ln 1119 W Drake Rd Ste C-28
Bellvue, CO 80512 Fort Collins, CO 80526-2476 (139/309)
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.
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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 terms, exclusions, and conditions of such policies.
TYPE OF INSURANCE
POLICY NUMBER
LIMITS OF LIABILITY
EFFECTIVE EXPIRATION
(Mo. Day. Yr Mo Day, Yr
Homeowners!
Bodily Injury and Property Damage
Mobilehomeowners Liability
Each Occurrence $ 000
Boatowners Liability
Bodily Injury and Property Damage
Each Occurrence $ ,Opp
Personal Umbrella Liability
Bodily Injury and Property Damage
Each Occurrence $ ,000
Farm/Ranch Liability
Farm Liability & Personal Liability
Each occurrence $ ,000
Farm Employees 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 $ 600 000
Products - Completed Operations A re ate $ 600,000
® Commercial General
Liability (occurrence)
❑
❑
05-X60802-01-00
9/14/2003
9/14/2004
Personal and Advertising Injury $ 300
Each Occurrence $ 300,0o0
Damage to Premises Rented io You $ 100 000
Medical Expense (Any One Person) $ 5 000
Businessowners Liability
Each Occurrencet t $ '000
Aggregatett $ ,000
Liquor Liability
Common Cause Limit $ .000
Aggregate Limit $ ,000
Automobile Liability
❑ Any Auto
Bodily Injury- Each Person $ 1000
❑ All Owned Autos
Bodily Injury -Each Accident $ 000
❑ Scheduled Autos
El Hired Auto
Property Damage $ p00
❑ Nonowned Autos
❑
Bodily Injury and Property Damage Combined $ 000
Excess Liability
❑ Commercial Blanket Excess
❑
Each Occunrence Aggregate $ 000
Other (Miscellaneous Covereaes)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS t The individual or partners shown as Insured ❑ Have ❑ Have not
Roofing 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.
• Cityof Fort Collins
PO Box 580
Fort Collins, CO 80522
Ar Ml " U .LLa
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.
0 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 I SUED
AU RIZE PRE TIVE
c
9/22/2003
U-201 Ed. 5100 Certificate Holder YtOck No. 06668 Rev. 7/02