HomeMy WebLinkAboutWOLF JEFFREY SHANNON STORMY PEAKS - INSURANCE CERTIFICATE12/6/2004 2:20 PM FROM: Fax TO: 2216707 PAGE: 001 OF 001
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDMlYY!
rr 1210612004
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Welsh Insurance - Fort Collins ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4033 BOARDWALK DR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 200
FORT COLLINS, CO 80525 INSURERS AFFORDING COVERAGE NAIC #
INSURED Wolf, Jeffrey & Shannon INSURER A. AUTO -OWNERS INS. CO.
DBA Stoney Peaks Construction INSURER B
246 Stoney Peaks Drive NSURER C,
Bellvue CO 80512 INSURER D
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
'L
POLICY NUMBER
POLICYEFFECTIVE
DATE iMMIDDNYi
POLICY EXPIRATION
DATE IMMI
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X
X COMMERCIAL GENERAL LIABILITY
74005474-04
0211112004
0211112005
DAMAGE TO RENTED$
100,000
CLAIMS MADE O OCCUR
MED EXP (Any oneperson)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP/OP AGG
$ 2,000,000
RO- LOC
X POLICY PigrT
A
AUTOMOBILE
LIABILITY
ANY AUTO
44153676.00
12M612003
1210612004
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per person)
$
X
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
X
X
HIRED AUTOS
NON OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY. AGG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR F—ICLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
WC STATU- OTH-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
EL EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED?
If yes, descnbe under
SPECIAL PROVISIONS below
E.L. DISEASE- POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
EXCAVATION
AUTO -OWNERS ADDITIONAL INSURED ENDORSEMENT 55202IS ATTACHED.
FOR LAKE STABILIZATION BID 5884
CERTIFICATE HOLDER CANCELLATION
CITY OF FORT COLLINS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
ATTN:JOHN STEPHEN
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATiV
5
FAX 2216707
ACORD 25 (2001/08) 1 0ACORD CORPORATION 1988