HomeMy WebLinkAboutROBERT V EWING - INSURANCE CERTIFICATE (2)CERTIFICATE 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 Agent's Name, Address and Phone Number (Agt./Dist.)
Robert V Ewing Kathy A. Collins (970) 225-6866
650 Redstone Lane 1119 W Drake Rd Ste C-28
Bellvue, CO 80512 Fort Collins, CO 80526-2476 (139/309)
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.
COVERAGE$
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 Inks 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
Homeowrters!
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 $ 1000
Fan Liability & Personal Liability
Farm/Ranch Liability
Each Occurrence $ ,000
Farm Employer's Liability
Each Occurrence $ 000
Workers Compensation and
statutory ..r...r.....
Each accident $ 000
Employers Liability t
Disease - Each Employee $ ,000
Disease -Policy Limit $ ,000
General Liability
General Aggregate $ 600 000
Products -Com leted Operations Aggregate $ 600 ,000
® Commercial General
Liability(occurrence)
❑
05-X60802-01-00
9/14/2004
9/14/2005
Personal and Advertising Inu $ 300 .000
Each Occurrence $ 300,000
❑
to Premises Rented to You $ 100 000
-Damage
Medical Expense (Any One Person) $ 5 000
BusinessownersLiability
Each Occurrencet t $ 000
Aggregatett $ ,000
Liquor Liability
Common Cause Limit $ ,000
Aggregate Limit $ '000
Automobile Liability
BodlyInjury - EachPerson $ 000
❑ Any Auto
❑ All Owned Autos
Bodily Injury - Each Accident $ 000
❑ Scheduled Autos
$
❑ Hired Auto
Property Damage 000
❑ Nonowned Autos
❑
Bodily Injury and Property Damage Combined $ '000
Excess Liability
❑ Commercial Blanket Excess
, ;��� y ' ,� r
Each Occurrence/Aggregate $ ,000
❑
Other (Miscellaneous Coveraces)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS t The individual or partners shown as insured ❑ Have ❑ Have not
Roofing elected to be covered as employees under this policy.
t t Products-Canpleted Operations aggregate is equal to each
occurrence limit and is included in policy aggregate.
CERTIFICATE )OLDER'S NAMl: ANI ADDRESS
CANCELLATION
• Cityof Fort Collins
Should any of the above described policies be cancelled before the
date '(
expiration thereof, the company will endeavor to mail days)
PO Box 580
written notice to the Certificate Holder named, but failure to mail such
Fort Collins, CO 80522
notice shall impose no obligation or liabilityof any kind upon the
company, its aghents or representatives. •10 days different
unless
number of days s own.
❑ 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
A11F4RIZE EP ESENTATI E
9/15/2004
I
U-201 Ed. 5100 Certificate Holder c'Stock No. 06668 Rev. 7102