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Home My WebLink AboutEMPIRE CARPENTRY - INSURANCE CERTIFICATE (7)CERTIMATE OF LIABILITY INSURANCE American Family Insurance Company n American Family Mutual insurance Company if selection box is not checked, 600OAmerican Pky Madison, Wisconsin 537MOW1 Agent's Name, Address and Phone Number (Agt.lnist.) Insured's Name and Address: Larry D Peterson (11 "09) Empire Carpentry LLC 149 W Harvard, Suits102 PO Box 245 Fort Collins,, CO 80525 Belivue, CO W512-0245 270-22"393 This cartifleatili N issued as a matter of Information onil and confers no rights upon the Certificate Holder, This certificate does not amend. extend or after the covwaaa afforded by the molielas gaped insinw- 7 —R 7 777"'777777 7`7777,777= -'*DVV Mft ' , . 7 i� This to to certify that Ildicias 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 doot ment %iitth respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described heroin Is subject to all the tarmis.(ixeluslons, and conditions of such Dolioles, POLICY TYPE TYPE OF INSURANCE POLICY NUMBER LIMITS OF LIABILITY Effective Expiration (Mo,Day,Yr) (Mo,DsV,Yr) Homeowners/ Bodlly Injury and Property Damage Moblishomeowners Liability Each Occurrence Boatowners Liability Bodily Injury and Property Damage Each Occurrence Personal Umbrella Liability Bodily Injury and Property Damage Each Occurrence FamVRench Liability Farm & Personal Liability Each Occurrence Farm Employer's Liability Each Occurrence StatUtDrY Workers Compensation and Each Accident Employers Liability Disease - Each Employee Disease - Policy Limit Gartaeall Liatolfity, General Aggregate $2,000,000 Commercial General 05-X16943 11/1 V2002 11113/20M Products - Completed Operations Aggregate $ 2,OW,000 Liability (occurrence) Personal and Advertising Injury $1,000.000 ❑ Each Occurranoa $1,000,000 ❑ Fire Damage (Any One Fire) $100,000 Medical Expense An One Person ) $ 5.000 Busineascrianairs Liability Each Occurrence + ArinfeWte * 4 Automobile Liability Bodily Injury - Each Person $11,0001000 Owned Autos (Basic fomn) 05-X90782 0OV0112003 09/01/2004 Bodily Injury - Each Accident $1,000,000 ❑ Owned Autos (Qwnp corm) Prop" Damage $1,0001000 ❑ Hired Autos Bodily Injury & Property Damage Combined ❑ Non -owned Autos Garage liability Excess Liability ❑ Commercial Blanket Excess Ewh OccurramaiAggregate DESCRIPTION OF QPF;RATIONSILOCATIONSNEHICLES/RESTRICTIONS/SPECIAL f I EMS The individual or partners shown as Insured *** elected lu be rnvered as employees under this policy. + + Products-Complated Operations aggregate is equal to each oce, irraftoo limit and is included in policy awnKlate. Should any of the above described policies be canceled before the City of Fort Collins Dept of Purchasing expiration date thereof, the company will endeavor to mail 1( 10 days) written PO Box MO to the Certificate Holder named, but failure to mail such notice "I Furl Collins, CO SM2 impose impose no obligation or liability of any kind upon the company, its agents or *10 Fax: 2214707 repiresentativals, clays unless different numbarof days shown. 0 This oanh* coverage on the date of !am@ only. The above described Attn: John Stephens policies sro subject to cancellation in conformity with their terms and by the laws of the state of issue. I DATE ISSUED AUTHORIZED RFPRLSENTATIVE I I iOW03 (P C. U-201 Ed. live ORIGINAL - Certificate Holder, COPIES to Services, insured, Agent Stock No. 06668 I,/i. 868d !Rd6t:7 CO-9-A0N !Z906 5au OL6 !9ouvjnsuJ ATTW8J UWOTJOWV :Ag ;u9s