HomeMy WebLinkAboutMARK MUTH GYVER L ELECTRIC - 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
Mark Muth DBA Gyver L Electric, LLC
PO Box 220
Wellington, CO 80549-0220
Agent's Name, Address and Phone Number (Agt./Dist.)
Daniel B Richmond (970) 484-2881
923 E. Prospect Rd
Fort Collins, CO 80525-1110 (125/309)
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.
COVERAGES
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
POLICY DATE
LIMITS OF LIABILITY
EFFECTIVE EXPIRATION
(Mo. Day, Yr(Mo. Day, Yr
Homeowners/
Bodily Injury and Property Damage
Mobilehomeowners Liability
Each occurrence $ 1000
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 000
Farm Employer's Liability
Each Occurrence $ 000
Workers Compensation and
Statutory ,„ , ,,t ,, t•
Each Accident $ 000
Employers Liability t
Disease - Each Employee $ ,000
Disease - Policy Limit $ ,000
General Liability
General Aggregate $ 2,000 000
Products -Com leted Operat;ons Aggregate $ 2,000 ,000
® Commercial General
Liability (occurrence)
Personal and Advertising Injury$ 1,000
❑
05-XE5525
3/10/2004
1/13/2005
Each Occurrence $ 1,000,000
❑
Damage to Premises Rented to You $ 1000 000
Medical Expense (Any One Person) $ 5 o0o
Businessowners Liability
Each Occurrencet t $ ,000
Aggregatett $ ,000
Liquor Liability
Common Cause Limit $ ,000
Aggregate Limit $ '000
Automobile Liability
Bodily Injury - Each Person $
❑ Any Auto
'000
❑ All Owned Autos
Bodily Injury - Each Accident $ '000
❑ Scheduled Autos
❑ Hired Auto
Property Damage $ 000
❑ Nonowned Autos
❑
Bodily Injury and Property Damage Combined $ '000
Excess Liability
❑ Commercial Blanket Excess
Each Occumence/Aggregate $ 000
❑
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RE TRIC710NS/SPECIAL ITEMS
,�� / � ✓� y v v
��
t The individual or partners shown as insured El Have ❑Have not
} / v /y P ,+� n lr- � ' ,,
4��tf/�J:
u - elected to be covered as employees under this policy.
✓,� ��L' �E�µ'��f�jF� / `,j'<�V'Y pl�n,� �>/
•'� i t t ProductsCompletetl Operations aggregate Is equal to each
,Hr,f
occurrence limit and is Included in policy aggregate.
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v Fl�ii4fG � F •.,�1 At�Mr�.'1+r�d�i iW�
CiANC""TION
• CITY OF FORT COLLINS
LKJ Should any of the above described policies be cancelled before the
date •(
expiration thereof, the company will endeavor to mail 10 days)
P O BOX 580
written notice to the Certificate Holder named, but failure to mail such
FORT COLLINS CO 80522
notice shall impose no obligation or liability of any kind upon the
its •1y0
company, agents or representatives. days unless different
number of days shown.
❑ This certifies coverage on the date of issue only. The above
described policies are subject to cancellation in conformity with their
terms and by the laws of the state of issue.
DATE ISSUED
3/25/2004
AUTH IZE REPRE ENT TVE
U-201 Ed. 5100 Certificate Holder
Stock No. 06668 Rev. 7102