HomeMy WebLinkAboutRAMIRO LOPEZ CRISTALS ROOFING - 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
Ramiro Lopez DBA Cristal's Roofing
2100 Ideal Lane
Fort Collins, CO 80524
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 emend, extend or alter the coverage afforded by the policies listed below.
COVERAGES
This is to certity 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
Bodily 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
Farm Employer's Liability
Each Occurrence $ 000
Workers Compensation and
Statutory ++++++++++++
Each Accident $ '000
Employers Liability t
Disease - Each Employee $ ,000
Disease - Policy Limit $ 1000
General Liability
General Aggregate $ 2,000 Opp
Products - Completed Operations A re ate $ 2,000,000
® Commercial General
Liability (occurrence)
Personal and AdvertisingInjury $ 1.000 000
❑
05-X95948-01-00
9/82004
9/8/2005
Each Occurrence $ 1,000 ,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 occurrence/Aggregate $ 000
El
4
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS
t The intlivitlual or artnere shown as Insuretl —]Have [—]Have not
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r l/or j o•. / e a, 6'r�
y rr r r ,r elected to be covered as employees under this li
�P Pon Pis
r < fen ,� /
'/' �
u� Sri
° tt Products-CompletedOperations aggregate is equal to each
%/ � � ��, �r , , ° a r3' ✓ n °� a r/ � n�,9'r
r r r-re„ ar o ,�,�,✓�, ,.o '�, r �, ,'r PF +�z •�ir, %, , e, �/.c>a r,
F � � ,tr occurrence limit end is included in policy aggregate.
, r, , �, .,Nv. and
CERTIFICATE 1fOLOER'S NAME ANG ADORESS
cANCELLaTwN
•
LIG Should any of the above described policies be cancelled before the
City of Fort Collins
expiration date thereof, the company will endeavor to mail'( 10 days)
written notice to the Certificate Holder named, but failure to mad such
P O Box 580
notice shall impose no obligation or liability of any kind upon the
Fort Collins CO 80522
oom any, its agents or representatives. 0 days unless different
number of days shown.
f 224-6134
❑ 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
A O EPRESENTATIVE
9/8/2004
� /
U-201 Ed. 5/00 Certificate Holder L//�/�"ll/// — ✓, Stock No. 06668 Rev. 7/02