HomeMy WebLinkAboutVERNS CUSTOM COUNTER TOPS KIRK WEIGANG - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE DEC 2 $ 2005
American Family Insurance Company El
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.)
Kirk Weigang Daniel B Richmond (970) 484-2881
IDEA Vems Custom Counter Tops 923 E. Prospect Rd
1024 W Prospect Rd. Fort Collins, CO 80525-1110 (125/309)
Fort Collins, CO 80526-1926
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.
COVEiAGES i
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. Yr Ma 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
Farm/Ranch Liability
Each Occurrence $ '000
Farm Employer's Liability
Each Occurrence $ 000
Workers Compensation and
Statutory ,....:......
_ __
Each Accident $ 1000
Employers Liability t
Disease - Each Employee $ ,000
Disease -Policy Limit $ ,000
General Liability
General Aggregate $ 1,000 000
Products - Completed Operations Aggregate $ 1,000,000
® Commercial General
Liability (occurrence)
❑
05-XE4646-03-00
7/3/2005
7/3/2006
Personal and Advertising Injury $ 500,000
Each Occurrence $ 500,000
❑
Damatie to Premises Rented to You $ 100 0()0
Medical Expense (Any One Person) $ 5 000
Businessowners Liability
Each Occumancet t $ ,000
Aggregatett $ ,000
Liquor Liability
Common Cause Limit $ ,000
Aggregate Limit $ '000
Automobile Liability
Bodily Injury - each Person $ 250,000
❑ Any Auto
❑ All Owned Autos
Bodily Injury- Each Accident $ 500,000
® Scheduled Autos
05-XE4646-02-00
7/9/2005
7/9/2006
$
Property Damage 250 ,000
❑ Hired Auto
❑ Nonowned Autos
Bodily Injury and Property Damage Combined $ 000
Excess Liability
❑ Commercial Blanket Excess
w e
Each Occurrence/Aggregate $ 000
Other (Miscellaneous Coverecesl
DESCRIPTION OF OPERATIONS/LO LOCATIONS VEHICLES/RESTRICTIONS/SPECIAL ITEMS t p ❑Have not
�y �„<. a q 1 r F The Individual or partnersshown as Insured Have
,r a1-0
�,'",.0 w"r "Y`y�';�'"'/�Y, ,�� �� �� elected to be covered as employees under this policy.
� tt Products -Completed Operations aggregate Is equal to each
� ,s �? occurrence limit and is inducted In policy aggregate.
RT1f=tCAl'E�OCI�ER'SNAMEArtIT�:ADdFiES3, "GI►i�C):tt�i1.O�I ,, `-
• City of Fort Collins
Should any of the above described policies be cancelled before the
expiration date thereof, the company will endeavor to mail'( 10 days)
Purchasing Department
written notice to the Certificate Holder named, but failure to mail such
2555 Midpoint Dr.
notice imposeobligation orliability of any kind upon the
its p TO days unless different
of
Fort Collins, CO 80525
number 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.
Ph
DATE ISSUED
All
9
RIZED KJ:VKt5 ATIVE
12/27/2005
I
U-201 Ed. 5/00 Certificate Holder Stock No. 06668 Rev. 7/02