HomeMy WebLinkAboutWRIGHT BALLARD CONSTRUCTION - INSURANCE CERTIFICATE (5)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
Insured's Name and Address Agent's Name, Address and Phone Number (Agt./Dist.)
Wright Ballard Construction, Inc Lesa Flingkjob
6821 Aaron Drive 375 E. Horsetooth Bldg 6 Ste. 100
Fort Collins, CO 80521 Ft. Collins, CO 80525
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.
Cr3VERAGEs
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
EFFECTIVE EXPIRATION
(Mo. Day, Yrl Mo. Day, Yr
Homeowners/
Bodily Injury and Property Damage
Mobilehomeowners Liability
Each occurrence $ 000
Boatowners Liability
Bodily Injury and Property Damage
Each Occurrence $ ,000
Personal Umbrella Liability
Bodily Injury and Property Damage
Each Occurrence $ ,000
Farm Liability & Personal Liability
Fann/Ranch Liability
Each Occurrence $ '000
Farm Employer's Liability
Each Occurrence $ 000
Workers Compensation and
Employers Liability t
05-X34845-91-00
02/18/2004
02/18/2005
Statutory .........+..
Each Accident $ 100,000
Disease -Each Employee $ 100 1000
Disease - Policy Limit $ 500 ,000
General Liability
® Commercial General
General Aggregate $ 2,000 000
Products - CompletedOperationsA reate $ 2,000,000
Personal and Advertising Injury$ 1,000,000
Liability (occurrence)
❑
05-X92387
04/01/2004
04/01/2005
Each Occurrence $ 1,000 ,000
❑
Damage to Premises Rented to You $ 100 000
Medical Expense (Any One Person) $ 5 000
Businessowners Liability
Each Occurrencet t $ 000
Aggregatett $ ,000
Liquor Liability
Common Cause Limit $ ,000
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
Bodily Injury and Property Damage Combined $ 000
❑ Nonowned Autos
11
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 El Have ❑Have not
` ` �� elected to be covered as employe" under this policy.
i i , 1u ,1� ✓ < r 1 r , 40 i� ��r,<`: e,1 H ,; ,�/ �r�P cY
„�d„ i / �' 1 ey ' t t Products -Completed Operations aggregate is equal to each
f�,, ,f<"�✓f�?�, •/...r ,1g ., a1�. Gl,f. �. rK�u 7 occurrence limit and is Included in Polity aggregate.
CERTIFICATE HDLDER`S NAME "AND ADDRESS
CANCELLATION
• City of Fort Collins
Purchasing Dept.
281 N College Ave
9
Fort Collins, Co. 80524
El Should any of the above described policies be cancelled before the
expiration date thereof, the company will endeavor to mail '( days)
written notice to the Certificate Holder named, but failure to mail such
notice shall impose no obligation or liability of any kind upon the
company, its a%ents or representatives. 'TO days unless different
number of days s own.
® 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 s to of issue.
DATE ISSUED
A R D R SENTAI IVE
03/23/2004
U-201 Ed. 5/00 Certificate Holder St o. 06668 Rev. 7/02