HomeMy WebLinkAboutEMPIRE CARPENTRY - INSURANCE CERTIFICATE (5)CERTIFICATE OF LIABILITY INSURANCE
American Family insurance Company ❑
American Family Mutual Insurance Company If selection box Is not checked.
f3000 American Pky Madison, Wisconsin 53783-0001
Agenra Name, Address and Phone Number (Agt./Diet.) Insured's Name and Address:
Larry D Peterson (119/309) Empire Carpentry LLC
149 W Harvard, Sufte102 PO Box 245
Fort Collins„ CO 80525 Bellvue, CO 80512-0245
970-229-9393
This certificate is issued as a matter of Information only and confers no rights upon the CBrtIlicaee Holder.
This cartiflcatw down not nmwnrf_ attend n. If. tr.e rn.ro•s .e aN.. 4. __n_:_ n,A r_,_._.
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 oonditlon 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 tronditlons of such dollcies.
POLICY
TYPE
TYPE OF INSURANCE
POLICY NUMBER
LIMITS OF LIABILITY
Effective
Expiration
N o Da Yr
Mo,Da ,Yr
Homeowners!
Bodily Injury and Property Damage
Mobilehomeownars Liability
Each Occurrence
Boatownere Liability
Bodily Injury and Property Damage
Each Occurrence
Personal Umbrella Liability
Bodily Injury and Property Damage
Each Occurrence
Form/Ranch Liability
Farm & Personal Liability Each Occurrence
Farm Employe s Liability Each Occurrence
Statutory ... .
Workers Compensation and
Each Accident
Employers Liability+
Disease - Each Employee
Disease - Policy Limit
General Liability
General Aggregate $ 2,000,000
® Commercial General
05-XlCIM-14
10/30/2004
70/30/20o5
Products - Completed Operations Aggregate $ 2,000,000
Liability (occurrence)
Personal and Advertising Injury $ 1,000,000
11
Each Occurrence $ 1,000,000
❑
Fire Damage (Any One Fire) $100,000
Medical Expense (Any One Person 5 000
Businessowners Liability
Each Occurrence + +
Anorequie + +
Automobile Liability
Bodily Injury - Each Person $100,000
® Owned Autos (Basic form)
05-X90782-02
09/01/2004
09/01/2005
Bodily Injury - Each Accident $30o,000
0 Owned Autos (Comp form)
Property Damage $100,000
❑ Hired Autos
Bodily Injury & Property Damage Combined
�] Non -owned Autos
❑ Garage liability
Excess Liability
Commerclal Blanket Excess
Each Occurrence/Aggregate
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS✓SPECIAL ITEMS
+The individual or partners shown as Insured ..• elected to be
The City of Fort Collins Department of Purchasing Is listed as an additional Insured.
covered w empkWas under this policy.
++ Products -Completed Operations aggregate is equal to each
occurrence limit and is included in policy aggragate.
ADDITIONAL INSURED
City of Fort Collins
Dept of Purchasing
PO BOX 580
Fort Collins, Co BM22
Fax:221-5707
Attn: John Stevens
Ed.
® Should any of the above described pollutes be canceled before the
expiration date thereof, the company will endeavor to mail "( 10 days) written
notice to the Canlilcate holder named, but failure to mail such notice shalt
impose no obligation or liability of any kind upon the company, its agents or
representatives. 010 days unless different number of clays shown,
CJ This certifies coverega 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.
to
11 /08/2004�
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