HomeMy WebLinkAboutDEBBIE HIATT YES - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company if selection box is not checked.
SOW American Pky Madison, Wisconsin 53783.ONI
Insured's Name and Address Agent's Name, Address and Phone Number (Agt./Dist.)
Debbie Hiatt DBA YES Daniel B Richmond (970) 484-2881
2637 Shadow Ct 923 E. Prospect Rd
Fort Collins, CO 80525 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 rasped 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 $ ,000
Boatowners Liability
Bodily Injury and Property Damage
Each Occurrence $ ,000
Personal Umbrella Liability
Bodily Injury and Property Damage
Each Occurrence $ ,000
Fann/Ranch Liability
Farm Liability & Personal Liability
Each Occurrence $ ,000
Farts Employees Liability
Each Occurrence $ 000
Workers Compensation and
Statutory •t . t •iti.*
Each Accident $ 000
Employers Liability t
Dlseaw - Each Employee $ ,ow
Disease - Policy Limit $ ,000
General Liability
General Aggregate $ 1,000 000
Products - Completed Operations A r ate $ 1,000 ,000
(M Commercial General
Liability(occurrence)
❑
❑
05 XF0031-01-00
6(5(2004
6(5(2005
Personal and Advertising Injury $ 500-000
Each Occurrence $ 500 ,000
Damage to Premises Rented to You $ 100 000
Medical Expense (Any One Person) $ 5 o0o
Businessowners Liability
Each Oocurrencett $ 000
Aggregatett $ ,000
Liquor Liability
Common Cause Limit $ 000
Aggregate Limit $ .000
Automobile Liability
❑ Any Auto
❑ All Owned Autos
Bodily Injury - Each Person $ '000
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 Occurrence/Aggregate $ 000
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEM S t The individual or partners shown as insured [--]Have ❑ Have not
CONCESSIONAIRES VENDING CART IN OLD TOWN FORT COLLINS SELLING BOTTLED WATER AND elected to be covered as employees under this policy.
SHAVED ICE CONES t t Products -Completed Operations aggregate is equal to each
occurrence limit and is included in policy aggregate.
CERTIFICATE HOLOER`S NAME AND ADDRESS
CANCELLATION
•
CITY OF FORT COLLINS
ATTN DAVID CAREY
PURCHASING DIV
LKJ Should any of the above described policies be cancelled before the
expiration date thereof, the company will endeavor to mail '( 10 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 a ants or representatives. TO days unless different
number of days shown.
215 N Mason 2nd Floor
Fort Collins, CO 80524
❑ 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
D REPRESEN ATIVE
6/8/2004