HomeMy WebLinkAboutPREMIER FOUNDATIONS - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company if selection box is not checked.
6000 American Pity Madison, Wisconsin 53783-0001
Insured's Name and Address Agent's Name, Address and Phone Number (AgtJDist.)
Premier Foundations Inc Gary L. Johnson (303) 776-9870
2856 WCR 20 112 923 Main St.
Longmont, CO 80504 Longmont, CO 80501 (101/309)
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, tens 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
EFFECTIVE EXPIRATION
(Mo. Day. Yr(Mo. Day, Yr
Homeowners/
Bodily Injury and Property Damage
Mobilehomeowners Liability
Each occurrence $ 1000
Boatowner8 Liability
Bodily Injury and Property Damage
Each Occurrence $ ,000
Personal Umbrella Liability
Bodily Injury and Property Damage
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 $ 1,000 ,000
Employers Liability t
05-X33756-90 00
6/1/2004
6/1/2005
Disease - Each Employee $ 1,000 1000
Disease - Policy Limit $ 1,000 1000
General Liability
General Aggregate $ 4.000 000
Products -Com letedOperationsAggregate $ 4,000 ,00o
❑ Commercial General
Personal and Advertising Injury $ 2,000 ono
Liability (occurrence)
❑
05-X92894-27
O6/10/2004
06/10/2005
Each Occurrence $ 2,000 ,000
❑
Damage to Premises Rented to You $ 100 000
Medical Expense (Any One Person) $ 5 000
Businessowners Liability
Each Occunencett $ ow
Aggregatett $ '000
Liquor Liability
Common Cause Limit $ '000
Aggregate Limit $ ,000
Automobile Liability
Bodily Injury- Each Person $ ,000
❑ A
wne
❑ AllllOwned 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 Coverages)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS t The individual or partners shown as insured ❑ Have ❑ Have not
City of Ft. Collins shall be named as additional insured elected to be covered as employees under this policy.
t t Products -Completed Operations aggregate Is equal to each
occurrence limit and is included in policy aggregate.
CERTIFICATE HOLDER'S NAME AND ADDRESS
CANCELLATION
. City of Ft. Collins
Y
LJ Should any of the above described policies be cancelled before the
date '(
expiration thereof, the company will endeavor to mail days)
PO Box 580
written notice to the Certificate Holder named, but failure to mall such
Ft Collins, CO 80522
notice shall impose no obligation or liability of any kind upon the
' y0
company, its agents or representatives. days unless different
number of days shown.
® This certifies cover6en the date of issue only. The above
described policies areto cance ation in conformity with their
terms and by the laws ofto of issu
DATE ISSUED
AUTH RI D REP)SE
T TIV
6/16/2004
U-201 Ed. 5/00 Certificate Holder v Vv Stock No. 06668 Rev. 7/02