HomeMy WebLinkAboutJLK CONCRETE - INSURANCE CERTIFICATEACORD
PRODUCER
DATE (MMIDDIM
Manor Insurance Agency, Inc
1325 S Colorado Blvd Ste 210
Denver CO 80222
JLK Concrete DBA
James Happen
13600 hest 78th Avenue
Arvada CO 80005-2711
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE .
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES
COMPANY
-691-2565 A United Fire 6 Casualty
COMPANY
B
COMPANY
C
COMPANY
D
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 OR 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
LTR
7ypE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDDNY)
POLICY EXPIRATION
DATE (MMIDDIYY)
LIMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ®OCCUR
OWNER'S & CONTRACTOR'S PROT
60048728
11/04/04
11/04/05
GENERAL AGGREGATE
$ 1,000,000
X
PRODUCTS-COMPIOPAGG
$ 1,000,000
PERSONAL 3 ADV INJURY
$ 500,000
EACH OCCURRENCE
$ 500,000
FIRE DAMAGE (Any one fire)
$ 100,000
MED EXP (Any one person)
$ 5 000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
60048728
11/04/04
11/04/05
COMBINED SINGLE LIMIT
$ 1001
For perILY INJURY
(Per pswon)
n)$
X
BODILY INJURY
Per accident)
$
PROPERTY DAMAGE
$
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
7777777777777
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE
$
AGGREGATE
§
$
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY
THE PROPRIETOR!
PARTNERWEXECUTIVE INCL
OFFICERS ARE: EXCL
OTHER
WC STATJ- OTH-
TORY LIMITS ER
EL EACH ACCIDENT
$
EL DISEASE -POLICY LIMIT
$
EL DISEASE - EA EMPLOYEE $
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER: CANCELLATfON
CI TYFTC SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
City of Fort Collins -0 — DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
P.O. BOX 580 SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Ft. Collins CO 80522 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.