HomeMy WebLinkAboutALPHA OMEGA 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
John & Barbara Gonzales DBA Alpha Omega Electric
640 Kalmia Way
Broomfield, CO 80020-1898
Agent's Name, Address and Phone Number (Agt./Dist.)
Daniel A Bott (303) 452-6465
12000 N Washington St Ste 230
Thornton, CO 80241 (137/304)
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.
COYERAWES '
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 $ ,000
Boatowners Liability
Bactly injury and Property Damage
Each Occurrence $ ,000
Personal Umbrella Liability
Bodily Injury and Property Damage
Each Occurrence $ ,000
Farm Liability & Personal Liability
Farm/Ranch Liability
Each Occurrence $ 000
Fan Employers Liability
Each Occurrence $ 000
Workers Compensation and
Statutory +++++++++r++
Each Accident $ 000
Employers Liability t
Disease - Each Employee $ 1000
Disease - Policy Limit $ ,000
General Liability
General Aggregate $ 1,000 000
Products - CompletedOperationsA r ate $ 1,000 000
® Commercial General
Liability (occurrence)
❑
05-XF2684-01-00
9/2/2003
9/212004,000
Personal and Advertising Injury $ 500
Each Occurrence $ 500 000
❑
Damage to Premises Rented to 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
Bodily Injury- Each Person $ 000
❑ Any Auto
❑ All Owned Autos
Bodily Injury - Each Accident $ 000
❑ Scheduled Autos
$
Property Damage 000
❑ Hired Auto
❑ Nonowned Autos
❑
Bodily Injury and Property Damage Combined $ ,000
Excess Liability
❑ Commercial Blanket Excess
Each Occu ante Aggregate $ 000
Other (Miscellaneous Covereaes)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS
individual or partners shown asHave Have not
t The ❑
elected covered as employeeslunder this policy,
i f w� y �aa E� ✓�' N fi ✓
�� rim
r fP
�� '.ttProducs-Com lased Operations aggregate is equal to each
,✓i' �� � rSl"v'
occurrence limit and is included in di
policyaggregate.
CERTIFICATE HOLDER'S`NAME ANU ACRRESS.
CANCELLATION
• City Of Ft Collins
Y
Should any of the above described policies be cancelled before the
expiration date thereof, the company will endeavor to mail '( days)
P O Box 580
written notice to the Certificate Holder named, but failure to mail such
Ft Collins CO 80522-0580
notice shall impose no obligation or liability of any kind upon the
company, its agents or representatives. 0 days unless different
number of days shown.
IM 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.
FAX: 970-221-6782
DATE I SUED
AUT IZ REPRES ATI V
1 /812004
2 Y/Y/Y////
U-201 Ed. 5/00 Certificate Holder Stock No. G6668 Rev. 7/02