HomeMy WebLinkAboutMASTER ROOFING TERRY KEYES - INSURANCE CERTIFICATECERTIFICATE 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 (AgtJDist.)
Terry Keyes Barry G Gustafson (970) 669-9390
DBA: Master Roofing 1442 N. Taft Ave.
712 Country Acres Drive Loveland, CO 80538 (111/309)
Johnstown, CO 80534
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 after the coverage afforded by the policies listed below.
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 this certificate may be issued or my pertain, the insurance afforded by the policies described herein is subject to all the tens, exclusions, and conditions of such policies.
TYPE OF INSURANCE
POLICY NUMBER
POLICY DATE
LIMITS OF LIABILITY
EF o Ivy Mo IRRATION
Homeowners/
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 $ ,000
Farm/Ranch Liability
Farm Uability &Pomona] Liability
Each Occurrence $ 000
Farm Employers Uabllify
Each Occurrence $ 000
Workers Compensation and
Statutory .x•..•.x....
Each Accident $ 000
Employers Liability t
Disease - Each Employee $ ,000
Disease - Policy Umit $ ,000
General Liability
General Aggregate $ 2,000 000
Products - Coro eted OperationsAggregate $ 2,000 ,000
® Commercial General
Liability (occurrence)
❑
❑
05-X98906-04-00
1/30/2004
1/30/2005
Personal and AdvertisingInjury$ 1,000 ,000
Each Occurrence $ 1,000 000
Damage to Premises Rented to You $ 100 000
Medical Expense (Any One Person) $ 5
Busjnessowners Liability
Each Occurrencet t $ 000
Aggregatett $ ,000
Liquor Liability
Common Cause limn $ 000
Aggregate Umit $ ,000
Automobile Liability
❑ Any Auto
❑ All Owned Autos
Bodily Injury - Each Person $ 000
Bodily Injury - Each Accident $ 000
❑ Scheduled Autos
El Hired Auto
Property Damage $ 000
❑ NonOwned Autos
❑
Bodily Injury and Property Damage Combined $ ,000
Excess Liability
❑ Commercial Blanket Excess
Each Occurrence/Aggregate $ 000
Other (Miscellaneous Coverages)
DESCRIPTION OF E L ATI N !VEHICLE / RI TI /SPECIAL ITEM
as ; ` r r t The individual or partners shown as insured ❑ Have ❑ Have not
.t 11 r elected to be covered w employees policy.
pioyees under II
' � € t t Products -Competed Operations aggregate Is equal to each
C a 6 � i �,® �' i a �� � i`$ia (' � • �� i occurrence limb and is included in policy aggregate.
y
• CityOf Fort Collins
Additional Insured
PO BOX 580
Fort Collins, CO 80522
LJ Should any of the above described policies be cancelled before the
expiration date thereof, the company will endeavor to mail '( days)
written notice to the Certificate Holder named, but failure to mail such
notice shall impose no obligation or liability of any kind upon the
company, its agents or representatives. 'f0 days unless different
number of days shown.
Attn: Amy
® This certifies coverage on the date of issue only. The above
Fax: 224-6134
described policies are subject to cancellation in conformity with their
terms and by the laws of the state of issue.
DATEISSUE
AUit%JPH1ZtlJ4E E
2/17/2004
U-201 Ed. 5✓00 Certificate Holder Stock No. 06668 Rev. 7/02