HomeMy WebLinkAboutJOE MOE DBA A J ELECTRIC - INSURANCE CERTIFICATEACORD� CERTIFICATE OF LIABILITY INSURANCE
DATE( 7/2004
10/27/2004
PRODUCER (970) 484-2805
John C. Beckett & Associates, Inc.
220 Smith Street
Ft. Collins CO 80524-
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 BELOW.
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
JOHN MOE DBA: A-J Electric
1108 Greenbriar Drive
- - —
Fort Collins CO 80524-
INSURER A: UNITED FIRE & CASUALTY
INSURERB:
INSURER C:
INSURER D:
INS( PRERS:
Ca%
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.
INSR
LTR
ADWL
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDDIYY)
POLICY EXPIRATION
DATE (MMIDDIM
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FKOCCUR
60304907
/ /
12/12/2004
/ /
12/12/2005
EACH OCCURRENCE
$ 300,000
DAMAGE TO RENTED
PREMISES(Ea occurrence
100 000
S r
MEDEXP (Any one arson
$ 5,000
PERSONAL B ADV INJURY
$ 300,000
GENERAL AGGREGATE
$ 600,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X1 POLICY 1 JEC LOC
PRODUCTS - COMPIOP AGG
$ 600,000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEDAUTOS
HIRED AUTOS
NON -OWNED AUTOS
NO COVERAGE
/ /
/ /
/ /
/ /
/ /
/ /
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Par accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
NO COVERAGE
/ /
/ /
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGO
$
$
EXCESWUMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
NO COVERAGE
/ /
/ /
/ /
/ /
EACH OCCURRENCE
$
AGGREGATE
$
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
NO COVERAGE
/
I TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE$
E.L. DISEASE - POLICY LIMIT
$
OTHER
NO COVERAGE
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLEWEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CITY OF FORT COLLINS
P.O. BOX 580
ACORD 25 (2001108)
(970) 224-6134 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION 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
AUTHORIZED REPRESENTATIVE
CO 80522-
C:
1988
ttT,�- INS025(oloe).os
ELECTRONIC LASER FORMS, INC. - (800)327-0545
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