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Home My WebLink AboutDIVISION IV MASONRY - INSURANCE CERTIFICATE09/08/2004 13:56 9705874955 HUSTON AGENCY PAGE 02 Insured's Name and Address ❑iVlsion IV Masonry 2925 56th Ave Greeley, CO 80634 CERTIFICATE OF LIABILITY INSURANCE American Family insurance Company ❑ American Family Mutual Insurance Company it selection box is not checked. 60M American Pky Madison, Wrownsin 53783-0001 Agent's Name, Address and Phone Number (Apt/Dist.) Don W. Huston 3 South Parish Ave Johnstown, CO 80534 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 after the coverage afforded by the policies listed below. co%MRAQffB ` 77 This Ia to cenily dvat DvIom of Insurance hated WM Mare been Ieaued m th► insured named above for the poesy petlotl Incanted, notwldlstanang any raauifemant, tens or contfldon of anY comraa a alner d0oumwrt wxn reepact to wneft thla owlfts% may ba bayed a may panels, tM Mower" afforded by Ina polidos oaecaaad heron Is aUpled to at the terms. oxchmons, arb condlftw Of elldtl P01116M. TYPE OF INSURANCE POLICY NUMBER LIMITS OF LIABILITY vYr EXPIRATION MFecr Homeowners/ Badly Injury and property carnage Mobilehomeowners Liability Eaeh ocaurrange $ 1000 f3oetoWMrs Liability eodM syury and Property cartage EachOccunarce $ .000 Personal Umbrella Liability Of Aty Nury and Prcpeny Demago Each Occurrence $ .DOO Farm/Raneh Liability arm LIablYty araonal Llabillly Each0courrawo 1000 Farm Employers Llabsity Each 000unanea $ .000 Workers Compensation and Statutory •*•••••«"*.* _ Each ADCWerd $ 500,000 Employers Liability t 05-XE2969-02 0510612004 O6/06/2005 Deaeea - Each Employee $ 500.000 oloam" POKY Umx $ 500,000 General Liability GonarolAgone ato $ 2,000 O00 Product. - OcmaetedOarat"A rests S 2,000000 ® Commercial General Liability (Occurrence) ❑ 05•XE2969-01 00 11 /0112003 11101 I2004 Personal andAdvartka f u $ 1.000 ma r0h I)ccurrenea $ 1.000 ,000 ❑ Damage to Premleaa panted to You $ 100,000 Medical f enae (Any Coe Parson) $ 5 Ogg Bue(nebtWWMre Liability Each 0"urrarcat" 1 $ ,000 Aggregaft $ 1000 Liquor Liability Common cause umk $ 'OW Aggregate Luna $ ,000 Automobile Liability SWIly Injury - Each Parson $ 500,000 m Any Auto ❑ All Owned Autos 0odly Injury - Each AOddem 1000 ,000 Property can" $ 250,000 ❑ Scheduled Autos 05-XE2969-03 05/15/2004 05/15/2005 ❑ Hired Auto Bodily ln)ury and Property Ogmpge Gombin9d $ 1000.000 ❑ Nonowned Autos ❑ Excess Liability © Cornmerclal Blanket Excess 0 y 11/01/2003 11/01/2004 each occurrence/Aggregate $ 1,000 ,000 Other (Miscellaneous Covereass) ULTORIPTION CIFOPERATIONS I LOCATOW VCHICLESJ REMICTIONS / SPECIAL ITEMS t The Individual of partnerselwwnae Insured lD Move 011wa not City of Ft C011ln$ fisted as additional insured elected to be covered as emplove9e uM9r Mk pdAey. tt Pfoducts-comoned opstaims sow"ato is swat to each Alternate Fuels at Transfon la job name o,,urrenc* lent and B lwuded In "ICY 899re01a. CERTIFICATE HOLD,ER'S !!I(Uliir ANO ADDRESS CANCELLATION, Should any of the above de�rlbed policies be cancalled before the days) " exppiation date thereof the company w1A endeavor to mail'( written notice, t0 the GroilNICa19 Holder named, but IAilure t0 mAll such City of Ft Wigs Mason $t $11 notice shall Impose no obligation or fiabill ty00 anyuk 0 udtNnere e " 215 N company, its a9gante Ot reprsson tAtvea. number of days snown. Ft Collins, Co ❑ This cttrtifies coverage on the data of issue only. The above described policies are subject to cancellation In conformity with It terms and by the laws of the state of issue. ,y.-- 09/0812004 U-201 Ed. WOO Certificate Hower Stock No- W888 Rev. 7102