HomeMy WebLinkAboutVOGEL - INSURANCE CERTIFICATE (4)Sep 17 04 01:35p RMFRM 3036951103 p.2
CERTIFICATE 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
Agent's Name, Address and Phone Number (Agl ist.) Insured's Name and Address
HAROLD F. LEE (1271305) VOGEL CONCRETE INC
2950 SO JAMAICA CT STE 100 1313 BLUE SPRUCE DRIVE B
AURORA, CO 80014 FT COLLINS CO 80524
303-695-1040
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.
CUV OES
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 olicies.
POLICY TYPE
TYPE OF INSURANCE
POLICY NUMBER
LIMITS OF LIABILITY
Effective
I Expiration
Mo,Da ,Yr
Mo,Da ,Yr
Homeowners/
Bodily Injury and Property Damage
Mobilshomeowners Liability
Each Occurrence
Bostowners Liability
Bodily Injury and Property Damage
Each Occurrence
Personal Umbrella Liability
Bodily Injury and Property Damage
Each Occurrence
Farm/Ranch Liability
Farm & Personal Liability Each Occurrence
Farm Em to er's Liability Each Occurrence
Statutory
Workers Compensation and
Each Accident
Employers Liability +
Disease - Each Employee
Disease - Policy Limit
General Liability
General Aggregate $ 2,000,000
® Commercial General
05-X60979-13
1/l/2004
1/1/2005
Products - Completed Operations Aggregate $ 2,000,000
Liability (occurrence)
Personal and Advertising Injury $ 1,000,000
❑
Each Occurrence $ 1,000,000
❑
Damage to Premises Rented to You $ 100,000
Medical Expense (Any One Person $ 5,000
Businessowners Liability
Each Occurrence ++
Augrepate + +
Liquor Liability
Common Cause Limit
Aggregate Limit
Automobile Liability
Bodily Injury - Each Person $ 1,000,000
❑ Any Auto
Bodily Injury- Each Accident $ 1,000,000
® All Owned Autos
05-X60979.46
1/1/2004
1/1/2005
Property Damage $ 1,000,000
❑ Scheduled Autos
Bodily Injury & Property Damage Combined
® Hired Autos
® Nonowned Autos
Excess Liability
® Commercial Blanket Excess
05-X60979-15
111/2004
1/1/2005
Each Occurrence/Aggregate $ 1,000,000
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIRESTRICTIONS/SPECIAL ITEMS
+The individual or partners shown as Insured ••' elected to be
ADDITIONAL INSUREDS: CITY OF FT COLLINS
covered as employees under this policy.
++ Products -Completed Operations aggregate is equal to each
occurrence limit and is included in policy aggregate.
CERTIFICATE HOW ER'S NAME AND ADD ESS`
CANCELLATION
® Should any of the above described policies be canceled before the
CITY OF FT COLLINS
PURCHASING DEPARTMENT
expiration date thereof, the company will endeavor to mail '(30 days) written
ATTN: JAN
notice to the Certificate Holder named, but failure to mail such notice shalt
PO BOX 560
impose no obligation or liability of any kind upon the company, its agents or
FT COLLINS CO 80522-0550
representatives. `10 days unless different 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 ISSUED
AUTHORIZED REPRES NTATIVE
09/17/2004
1
r ZA-0
U-201 Ed. 06100 ORIGINAL - Certificate Holder, COPIES to Services, Insured, Agent f f1 Stock No. 06668