HomeMy WebLinkAboutTHOMAS HARRIS T HARRIS CONSTRUCTION - 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
Thomas Harris DBA T Harris Construction
749 S Lemay A3 PMB176
Fort Collins, CO 80524
Agent's Name, Address and Phone Number (Agt./Dist.)
Daniel B Richmond (970) 484-2881
923 E. Prospect Rd
Fort Collins, CO 80525-1110 (125/309)
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 alter the coverage afforded by the policies listed below.
COVERAGES -
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 may pertain, the insurance afforded by the policies described herein Is subject to all the terms, exclusions, and conditions of such policies.
TYPE OF INSURANCE
POLICY NUMBER
POLICY DATE
LIMITS OF LIABILITY
F C IVv EXPIRATION TION
Homeowners/
Bodily Injury and Property Damage
Mobilehomeowners Liability
Each Occurrence $ .000
Bodily Injury and Property Damage
Boatowners Liability
Each Occurrence $ ,000
Bodily Injury and Property Damage
Personal Umbrella Liability
Each Occurrence $ ,000
Farm Liability & Personal Liability
Farm/Ranch Liability
Each Occurrence $ 000
Farm Employer's Liability
Each Occurrence $ 000
Workers Compensation and
Statutory ++++++++++++
Each Accident $ 0()0
Employers Liability t
Disease - Each Employee $ ,000
Disease - Policy Limit $ ,000
General Liability
General Aggregate $ 0 000
Products - Completed Operations A re ate $ ,000
M Commercial General
Personal and Advertisln Injury $ D 000Each
Liability (occurrence)
Liability
1-1
01/19l2004
01/19/2005
Occurrence $ 0 ,000
❑
Damage to Premises Rented to You $ 000
Medical Expense (Any One Person) $ 0 000
Each Occumenoett $
Businessowners Liability
,000
Aggregatett $ ,000
Common Cause Limit $ ,000
Liquor Liability
Aggregate Limit $ ,000
Automobile Liability
Bodily Injury- Each Person $ ,000
Any Auto
❑ All Owned Autos
Bodily Injury - Each Accident $ 000
Property Damage $ 000
❑ Scheduled Autos
❑ Hired Auto
❑ Nonowned Autos
❑
Bodily Injury and Property Damage Combined $ 000
Excess Liability
❑ Commercial Blanket Excess
Each Occurrence/Aggregate $ '000
Other (Miscellaneous Coveraces)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS
tThe individual or partners shown as insured El Have ❑Have not
Jy j'y �- eladetl to be covered as employees under this policy.
�� err ✓ ,,f r r "a� f�>fr>Ne� `, ! JY
rr 9„j, r�l '.tt Products -Completed Operations aggregate is equal to each
r 7/ > iN , r✓A i� err rJ
occurrence limit and is included in policy aggregate.
0ERTit=1GATE HOLDER'S NAME ANO ADORESS
CANCELLATION
• City of Fort Collins
LKI Should any of the above described policies be cancelled before the
expiration date thereof, the company will endeavor to mail'( 10 days)
P O Box 580
written notice to the Certificate Holder named, but failure to mail such
Fort Collins CO 80522
notice shall impose no obligation or liabilityof any kind upon the
its *10 days unless different
company, agents or representatives.
f-224-6134
number of days shown.
❑ This certifies coverage on the date of issue only. The above
•
described policies are subject to cancellation in conformity with their
terms and by the laws of the state of issue.
DATE I SUED
RI REPR ENTATIVE
06/14/2004
U-201 Ed. 5/00 Certificate Holder Stock No. 06668 Rev. 7/02