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Home My WebLink AboutEMPIRE CARPENTRY - INSURANCE CERTIFICATE (6)CERTIFICATE OF LIABILITY INSURANCE Amerfoan Family Insurance Company ❑ American Family Mutual Insurance Company if selection box Is not checked. 6000 American Pky Madison, Wisconsin 53783-0001 Agenya Name, Address and Phone Number (Agt./Dist.) Insureds Name and Address Larry D Peterson (119/309) Empire Carpentry LLC 149 W Harvard, Suite102 PO Box 246 Fort Collins„ CO 80525 Bellvue, CO 00512-0245 970-228-9393 This certificate t$ Issued e$ a matter of information or ly and confers no rights upon the Certificate Holder. This certificate does not amend. extend or after the cc'vemae afforded by the policies listed below. ✓. nn7dnr Ni. ,, ,r,.e 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 do mment with rasped to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein 16 subject to all the terms, exclusions, and conditions of such licies. POLICY TYPE TYPE OF INSURANCE POLICY NUMBER Effective Expiration LIMITS OF LIABILITY Mo Da Yr Mo Da Yr Homeowners/ Bodily Injury and Properly Damage Mobtlehomeownere Liability Each occurrence Boatowners 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 Em rs Liability Each Occurrence Statutory Workers Compensation and Each Accident F_rnployars Liability Disease - Each Employee Disease - Poliq Limit General Liability General Aggregate $ 2,000.000 ® Commercial General 05-Xi8Q43 11/13/2003 11/13/2004 Products - Completed Operations Aggregate $ 2,000.000 Liability (occurrence) Personal and Advertising Injury $ 1,000.000 Each Occurrence $ 1,IXI01000 Firr. Damage (Any One Fire) $ 1001000 Mf4eal gxj*ose,(Any One Person $ 5,000 Buslnassownere Llability Each Occurrence ++ Aggregate ++ Automobile Liability Bodily Injury - Each Person $110001000 Owned Autos (Basic form) 05-X90782 0010112003 09/01/20064 Bodily Injury - Each Accident $1,000,000 Owned Autos (Comp form) Property Damage $1,000.000 ❑ Hired Autos Bodily Injury & Property Damage Combined ❑ Non -owned Autos ❑ Garage liability Exec" Liability ❑ Commercial Blanket Excess Eauh Occurrence/Aggragate DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLE$AIESTRIt:I'IONSISPECIAL ITEMS +The ky viouiNt apartners strewn as Insured - ' aleofa4to be The City of Fort Collins Department of Purchasing Is farad as an additional insured. rrw*red as employees under this policy. + + Produela-complatad operations aggregate Is equal to each Occurrence limit and is included in policy aorceela. tX .., b•,.,.•..ml�y:4+..,.,. .,.5".,. ;,:;�:�r'`.i f, � Fr.. � :.:. , n',.,;, :....; f';P•.,;. d k.,ra .,,,:.,az.:tr✓,.h,;:>...:,.. ,;..,,:zr:•!:;. ® Should any of the above described policies be Canceled before the ADDITIONAL INSURED City of Fort Collins expiration date thereof, the Company A endeavor to mail'(11a days) Written DW of Purchasing notice to the Cerfifrcate Haider named, but failure to mail such notice shall PO Box 580 Impose no obligation or liability of any kind upon the company, its agents or Fan Collins, CO 8o822 representatives. -10 days unless different number of days shown. Fax: 221-9707 Q This certifies coverage on the date of Isaua only. The above described Mine John Stephens policies are subject to Cancellation In conformity, with their terms and by are laws of the state of issue, DATE ISSUED AUTHORIZED REPRESENTATIVE 12/02/03 V- W r no. rnro OniiwNAL - usrnncete Molder, COPIES to Sery ees, Insured, Agent Stock No. OMS t/i, obed !WdZI"-E 80-Z-080 `•LB06 6ZZ OL6 `eoueJnsui /ITTIued ue0>:Jemy :/ig dues r ' , .. - PROWLER ........ .. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pmnacol Assurance AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 7501 E Lowry Blvd CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE DENVER CO 80230-7006 AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE MPANY A P➢nnacol Assurance T,aANY EMPIRE CARPENTRY LLC B 521.5 SYCAMORE ST FORT COLLINS CO 80521 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE I1SM BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM AND 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 SUMECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS CO I TYPE OF DMURANCE I POUCY NUMIER I ➢OUCY EFFECIME I POLICY EXPIRATION I LAUTS CIADISMADE V OCCUR OWNER'S A CONTRACTOR'S PROT ANY AUTO ALL OWNED AUTOS SO®ULED AUTOS HUM AUTOS NONOWNEDAUTOS MAGE L ARu ANY AUTO SODdYDUURY ROOMY TUURY UI�IDJ.A rORM WORKERS COMPENSATION AND &JWCSTATU- U OTHER TDHY LIMM EMPLOYERS, UARR.n'T A 15195e0 0910112003 09101n004 TM PROPRIETOR/PARTNERS ❑ TNCT. I EL INSEASE- POUCY LTSDr DcRCRtmoN of oPz%A*nom�ux^norsAEmCv%,sPEcw. rrEMR SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNFIMM COVERAGE DETAIL Charles Doggett APOLIUND (SR Syp't• 1T�06+Q+M:1-:-D 1<14YA liplval: 12�IS�I9A5 T'-:W:O� IT'lif CERTIFICATE HOLDER COPY JOHN STEPHEN CITY OF FP COLLINSIPURCHASING PO BOX 580 FORT COLLINS CO 80522-0580 POLICY NUMBER: 1519590 BUSINESS LOCATION: EMPIRE CARPENTRY LLC CLASSIFICATION OF OPERATION CLASS DESCRIPTION 564505 CARPENTRY -RESIDENTIAL COVERAGE COVERAGE RATING EFFECTIVE EXPIRES TYPE 09/01/2003 09/01/2004 EM PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Pinnacol Assurance AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 7501 E Lowry Blvd CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE DENVER CO 80230-7006 AFFORDED BY THE POLICIES BELOW. INSURED EMPIRE CARPENTRY LLC 521.5 SYCAMORE ST FORT COLLINS CO 80521 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM AND 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSTRANCfi POLICY NULHBBR PoLICY EFFECTIVE POLICY EXPIRATION LIMITS LIABILITY CLAIMSN(ADE u OCCUR OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE FIRE DAMAGE f , f➢e LIED am 1 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY HIRER AUTOS NONOWNEDAUTOS aa�ml PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY ...... :::. "' ANY ALTO EACH ACIDENT CFSS LIABILITY UMBRELLA FORXI WORKERS COMPENSATION AND ELIPLOYERS' LIABILITY WC STATU- I I OTHER p 1 1519590 09/01/2003 09/01/2004 EL EACH ACCIDENT IW (m THE PROPRIETORIPARTNERSI INCL EL DISEASE -POLICY LIMIT Mum EXECUTIVE OFFICERS ARE: EXCL ELDISEASE-EAEMPLOYEE $100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONS VEHICLESISPBCIAL TEEMS SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAHL 727246 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE JOHN STEPHEN EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL CITY OF FT COLLINS/PURCHASING _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, PO BOX 580 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR FORT COLLINS CO 805 2-0580 LIABILITY OF ANY HIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Charles Doggett APOL1i1NDC.SR .U4VTt I11W00412'42 15195W TIVUW I215119 12:W(NI IIW135 Dater 11/6/03 Time: 4t11 PM Tot 91970-221-6707 e Pinnacol Assurance Paget 002-003 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Pinnacol Assurance AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS 7501 E Lawry Blvd CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE DENVER CO 80230-7006 AFFORDED BY THF. POT TCTFC RFT nW INSURED EMPIRE CARPENTRY LLC 521.5 SYCAMORE ST FORT COLLINS CO 80521 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM AND 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECT IVE POLICY ETPIRATION WGEN�LA�R�TE IMITS LTR DAT OAT mnytle/ GENERAL LIABILITY OATECOMMERCIAL GENERAL LIABILITY P OP AGGCLAIMS MADE ❑ OCCUR INIUAYOWNER'S R CONTRACTOR'S PROT CEom I11e ANYAUTO COMBINED SING BODILY INRTRY ALL OW NED AUTOS SCHEDULEDAUTOS HIRERAUTOS BODILY ]WRY NON-CIwNED AUTOS eaiaem PROPERTY DAM RACE LIABILITY AUTO ONLY - E1 OTHER THAN At ANYAUTO EACH 1(l!1 EXCESS LIABILITV EAOI OCOURRENCE AGGREGATE UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND KiWCSTATU- OTHER I'MFLOYERS' LWBIllTV TORY LIMITS A 1519590 09/01/2003 09/01/2004 ELEACF[ACaDENT $100,000 ELDISEASE POUT LIMIT 500000 THEPROPRIFIORIPARTNEM INCL EL DISEASE - FA EMPLOYEE 100000 EXECUTIVE OFFICERS ARE: EXCL OTHER DMCRIMIONOROME TIONSfWD TIONS/VENICLBSISP IALff MS SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL 727246 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE IOHN STEPHEN EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL CITY OF FT COLLTNS/PURCHASING _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, PO BOX 580 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR FORT COLLINS CO 80522-0580 LIABILITY OF ANY HIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVI AUTHORIZED REPRESENTATIVE Charles Doggett APOLJUNDCSRSu 1111OM3t :r,12 151OZ UPdetM: 12/15/199612�W,I UWBS Date: 1i!/6/03 Time: 4:11 PM To: ® 91970-221-6707 CERTIFICATE HOLDER COPY Pinnacol Assurance Page: 003-003 JOHN STEPHEN CITY OF FT COLLINS/PURCHASING PO BOX 580 FORT COLLINS CO 80522-0580 POLICY NUMBER: 1519590 BUSINESS LOCATION: EMPIRE CARPENTRY LLC CLASSIFICATION OF OPERATION CLASS DESCRIPTION 564505 CARPENTRY -RESIDENTIAL COVERAGE COVERAGE RATING EFFECTIVE EXPIRES TYPE 09/01/2003 09/01/2004 EM