HomeMy WebLinkAboutCAPPS WELDING DON CAPPS - INSURANCE CERTIFICATEACM. CERTIFICATE OF LIABILITY INSURANCE DATE
08/18/2004
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
RiskPlan Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
659 4th Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
Longmont CO 80501—
INSURED INSURER A:COLORADO CASUALTY
CAPPS WELDING D13A INSURERS:
DON CAPPS INSURER C:
16 DENISE PLACE INSURER D:
LONGMONT CO B0501— INSURER E:
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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
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDIYY
I POLICY EXPIRATION
DATE(MMIDDIM
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FRI OCCUR
AP 0534423-03
12/04/2003
/ /
12/04/2004
/ /
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire)
$ 50,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
I GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYF-j JE 0 LOC
PRODUCTS -COMP/OP AGG
$ 2,000,000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
/ /
/ /
/ /
/ /
/ /
/ /
/ /
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
/ /
/ /
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EA ACC
AUTO ONLY: AGG
$
$
EXCESS LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
/ /
/ /
/ /
/ /
EACH OCCURRENCE
$
AGGREGATE
$
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
/ /
/ /
TORY LIMITS ER
EJ. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE$
E.L. DISEASE -POLICY LIMIT
Is
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSfVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
INSTALLATION SERVICE OR REPAIR
( ) — (970) 568-7494 FAX
THE CITY OF FORT COLLINS
281 N COLLEGE
PO BOX 580
FORT COLLINS, CO 80522—
mT9T@T-T&ZI.aC.wbl rT
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOT/ E-THEHOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO 1 SHALL I OSE-NO-OBLIGATION OR LIABILITY OF ANY KIND UPON THE
C[TRPCIRATION 79RR
qr INS026S (9910).02
ELECTRONIC LASER FORMS, INC. - (800)327-0545
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