HomeMy WebLinkAboutVOGEL - INSURANCE CERTIFICATE (6)Sep 17 04 01:35p nMFRM 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 (Agt./Dist.) Insured's Name and Address
HAROLD F. LEE (127/305) 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.
,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 temis exclusions, and conditions of such fides.
POLICY TYPE
TYPE OF INSURANCE
POLICY NUMBER
LIMITS OF LIABILITY
Effective
Expiration I
Mo Da ,Yr
Mo,Da ,Yr
Homeowners/
Bodily Injury and Property Damage
Mobilehomeowners Liability
Each Occurrence
Boatowners 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 Employer's Liability Each Occurrence
Statutory
Workers Compensation and
Each Accident
Employers Liability +
Disease - Each Employee
Disease - Policy L'xnit
General Liability
General Aggregate $ 2,000,000
® Commercial General
05-X60979-13
1/1/2004
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 (AfiX One Person $ 5,000
Businessowners Liability
Each Occurrence ++
Aqgreqate + +
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
1/112004
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
1/1/2004
1/1/2005
Each Oocurrence/Aggregate $ 1,000,000
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/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 HOLDER'S NAME AND ADDRESS.
CANCELLATION
S Should any of the above descdbed policies be canceled before the
CITY OF FT COLLINS
expiration date thereof, the company will endeavor to mail'( 30 days) written
PURCHASING DEPARTMENT
notice to the Certificate Holder named, but failure to mail such notice shall
ATTN: JAN
PO BO X AN
580INS
impose no obligation or rability of any kind upon the company, its agents or
FT COX CO 80522-0580
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
U-201 Ed. 06/00 ORIGINAL - Certificate Holder, COPIES to Services, Insured, Agent I Stock No. 06668