HomeMy WebLinkAboutHIGH PLAINS CONSTRUCTION MANAGEMENT - INSURANCE CERTIFICATECERTIFICATE 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.)
High Plains Constr Mgmt Llc Ella Washington Agency (303) 530-3444
7260 Oriole Lane 6525 Gunpark Drive, ste 360
Niwot, CO 80503-8785 Boulder, CO 80301 (045/311)
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 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
MobilehomeownersLiability
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/Ranch Liability
Farm Liability & Personal Liability
Each Occurrence $ ,000
Farm Employer's Liability
Each Occurrence $ 000
Workers Compensation and
Statutory
Each Accident $ '000
Employers Liability t
Disease - Each Employee $ ,000
Disease -Policy Limit $ ,000
General Liability
General Aggregate $ 2,000 000
Products - Completed Operations A re ate $ 2,000 ,000
® Commercial General
Liability (occurrence)
❑
05-X99701-03-00
8/16/2005
8/16/2006
Personal and AdvertisingInlury $ 1,000
Each Occurrence $ 1,000 ,000
❑
Damage 10 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 $ 250 ,000
❑ Any Auto
❑ All Owned Autos
Bodily Injury - Each Accident $ 500 oo0
❑ Scheduled Autos
05-X99701-02-00
8/17/2005
8/17/2006
Property $
❑ Hired Auto
Damage 250,000
❑ Nonowned Autos
❑
Bodily Injury and Property Damage Combined $ 500,000
Excess Liability
F ,
❑ Commercial Blanket EXCeSS
Each Occurrence/Aggregate $
❑
rr ,r�ra�/ f,y
,000
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS El Have not
r , ,- > < J - 4 F - t The individual or partners shown as insured ® Have
/
elected to be covered as employees under this policy.
t t Is equal to each
opoarrenceliimittleted and is inncudedrin policyregate
aggregate.
Cfi'iEICA ' 1��.EMEf1'*9NA�iIE`?l[�GI'ARD)!i�tS :'.,L`jkMCEtr4�71ON
• Cityof Fort Collins
LKJ Should any of the above described policies be cancelled before the
date '(
Additional Insured
expiration thereof, the company will endeavor to mail 30 days)
to the Certificate Holder but failure
Po Box 580
written notice named, to mail such
notice shall impose no obligation or liability of any kind upon the
company, its a ants or representatives. 0 days different
Ft. Collins,
unless
shown.
CO 80522-0580
number of days
❑ 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 is ue.
DATE IS LIED
HORIZ EP SENTATI
4/11 /2006
U-201 Ed. 5/00 Certificate Holder Stoftk No. 06668 Rev. 7/02