HomeMy WebLinkAboutVOGEL - INSURANCE CERTIFICATE (11)May-14-04 01:29P
P-01
CERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company it 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 (1271305) VOGEL CONCRETE INC
2950 SO JAMAICA CT STE 100 1313 BLUE SPRUCE DRIVE B
AURORA, CO 80014 FT COLLINS CO 80524
303-895-1040
This certificate is Issued as a matter of Information only and confers no rights upon the Certificate Holder.
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This ceruncate cross not amend,ex[erw w anm mvi;w •o a••�•�o-- •••——••_.__ .____ __
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 sub ect to all the terms excusions, and conditions of such icies.
POLICY TYPE
TYPE OF INSURANCE
POLICY NUMBER
LIMITS OF LIABILITY
Effective
Expiration
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 Ember's Liability Each Occurrence
Statutory
Workers Compensation and
Each Accident
Employers Liability +
Disease - Each Employee
Disease - Policy Limit
General Liability
® Commercial General
05-X60979-13
1/1/2004
1/112005
General Aggregate $ 2,000.000
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 $ 100,0()0
Medical Expense (Any One Person $ 5 000
Buslnessowners Liability
Each Occurrence ++
Aggregate + +
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 1/1I2004 1/1/2005 Each Occurrence/Aggregate $ 1.000,000
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS +The individual or partners shown as Insured ••• elected to be
covered as employees under this policy.
ADDITIONAL INSUREDS: CITY OF FT COLLINS ++ products -Completed Operations aggregate is equal to each
CONCRETE PHASE 11, BID # 5847 occurrence limit and is Included in policy aggregate.
CERTIFICATE HOLDER'S NAME AND ADDRESS
CANCELLATION
® Should any of the above described policies be canceled before the
CITY OF FT COLLINS RISK MGMT
expiration date thereof, the company will endeavor to mail •( 30 days) written
112 N HOWES
notice to the Certificate Holder named, but failure to mail such notice shall
FT COLLINS CO 80521
Impose no obligation or liability of any kind upon the company, its agents or
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 THORIZED REPRESEN ATIVE
05/10/04�
Stork No. 06668
U-201 Ed. 95100