HomeMy WebLinkAbout108979 A & L SERVICES - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company it selection box is not checked.
6000 American Ply, Madison, Wisconsin 53763-0001
11161.1 'S Name and Address Anemia Name. Address and Phone Number (Aal./Dist,)
Michael Feltz Sr - A & L Services LLC Daniel B Richmond (970) 484-2881
2329 W Mulbefry St 923 E. Prospect Rd
Fort Collins, CO 80521-3224 Fort Collins, CO 80525-1110 (006/316)
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 oddly that pi of insurance tided bel i halo been issued to Ibo insured named aU W¢ for the policy period indicated, nob'ilhrt,ormng any lequbemenl, tern) or omoddion of any Cori or spur
dissonant wilt, respect to ii this ce,li icCle nlay be Issued of may penal, He ins Wanes afforded by the poleiea described herein Is sUbkol 10 all this term¢, e%CIW imo, and o or iliom, of s00t1 peli0ie5.
TYPE OF INSURANCE
POLICY NUMBER
_ POLICYDAT�v__-
LIMITS OF LIABILITY
EFFECTIVE ExaIRATION'
Mo DajVMoDa Yr
HOrnee W nerS/
_
_
B ----- lnlury dad Properly Damage
Mobilehomeowners Liability
Each occurmri $ ,000
Boatowners Liability
Bodily Injury and Property Damage
„4
Each occuvence $ ,000
Personal Umbrella Liability
Bodily lnlury, Arid properly Damage
Each Occurence, $ ,000
Farm/Ranch Liability
_
Farm LtaUi l Personal LmUilily
Erich Occurrence
Farm Employer's Liability
Enid, OCCUu0nio $ OOO
Workers Compensation and
Statutory
each Accident $ ,000
Employers Liability t
Disease Each Employee $ ,000
Disease Polley Limit $ '000
General Liability
Cori Aggegme $ 2,000 000
fu-1 Commercial General
P(OdUCIa'COmplMed ppelall0115 A4g(CQ81G $ 2,000 ,000
Liability (occurrence)
0
05-XCr�070-03-00
4/28/2008
4/28/2009
Personal and ndVildnen fl;u, $ 1,000
Each Ocourmnco $ 1,0001000
❑
DamagemPremises Renmd to You $ 100 OOO
WdCal Expenso(Any Ono Poison) $ 5 ODO
Businessowners Liability
each occuvoncot t $ '000
Aggirodett $ '000
Liquor Liability
Comma. close Link
_ -
Aggregate Limit $ ,000
Automobile Liability
eory,wfwy Each Person $ 500,000
❑ Any Auto
O All Owned Autos
ii lnlury- rash Acbdoot $ 100,000
W Scheduled Autos
05-XC5070-02-00
6/25/2007
6/25/2008
property Damage $
® Hired Auto
50 ,000
® Nonowned Autos
Bodily Injury and Properly Iximage Combined $ 000
Excess Liability
O Commercial Blanket Excess
Each Occurrence/Aggregme $ 000
❑
Other (Miscellaneous Coveraaest
OESCHIPTION OF OPERATIONS/LOCATIDNS /VEHICLES/tiESTPoC'ilOeS /SPECIAL ITEM t'rhis individual or panneashown as insomd ❑Have ❑line not
The general liability coverage Marl is endorsed to include the City of Fort Collins as adi ilional insured on the elected to be covered as employees under this policy.
CG 20 W 07 96 endorsement - stale peal)its t t PoodudsAOmpleled Operations aggregate is equal to east,
ottfolai Ilnlit and is included in policy aggrsei
CERTIFICATE HOLDERS NAME AND ADDRESS
CANCELLATION
• City of Ft Collins
y
TDJ'—Shou any, of U)e above described Policies be cancelled -before the
`(
Purchasing Division
expiration dale thereof, the company will endeavor to mail 30 days)
written notice to the Certificate Holder named, but failure to mail such
P O Box 580
notice shall impose no obligation or liabilityy of any kind upon the
coo any, its agents or representatives, 'TO days different
Fort Collins Cc 8D524
unless
num�er of days shown.
❑ This certifies coverage on the data 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.
DATEISSUED AUftIORIZED REPRESENTATIVE
n IOrO, /2306
4-2
U-201 Ed. 5/00 Agent Stock No. 06668 Rev. 7102
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
Insureds Name and Address Agent s Name Address and Phone Number (Agt /Dist )
A & L Services LLC Daniel B Richmond (970) 484 2881
2329 W Mulberry St 923 E Prospect Rd
Fort Collins CO 80521 3224 Fort Collins CO 80525 1110 (005/316)
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
Th s s to cemfy that poi cas of so ance listed below he a been issued to the Insured named above for the pol cy period indicated notw thstand ng any requirement term or cord Lion of any contract or other
dor mart wth aspect to wh ch to s cent f cate may be as ad or may sale n the ins ranee alto ded by the poiic as best bed he ein is subject to all the terns exclusions and coned o s of such policies
TYPE OF INSURANCE
POLICY NUMBER
POLICY DATE
LIMITS OF LIABILITY
EFFECTIVE EXPIRATION
(Mo. Day. Yr Mo De Y
Homeowners/
Bodily Inj ry and Property Damage
Mobdehomeowners Liability
Each Occu a ce $ 000
BOalowners Liability
Bodily Injury and Property Damage
Each Occu re ce $ 000
Personal Umbrella Liability
Bodily In, ry and P clearly Damage
Each Occ rrence $ 000
Farm/Ranch Liability
Farm Lability & Personal L ab I ty,
$
Each Occur ante 000
Fa m Employers Liability
Each Occurrence $ 000
Workers Compensation and
Statutory , ., .,
Each Accident $ 000
Employers Liability t
D sease Each Employee $ 000
D sease Policy Limit $ 000
General Liability
Ge a at Agg agate 2000 000
_$
Products Completed Operaton$Aggregate $ 20000o0
® Commercial General
U
Liability
❑
05 XC5070 03 00
4/28/2008
4/28/2009
Personal and Ad arising Inu $ 1000 .000Each
Occurrence $ 1 000 000
❑
Damage to Premises Rented to You $ 100 000
Medical Expense (Any One Person) $ 5 0o0
Busmessowners Liability
Each Occurrencet t $ 000
Aggragatett $ 000
Liquor Liability
Common Cause Lim t $ 000
Aggregate L m t $ 000
Automobile Liability
Bodily Injury Each Person $ 50 000
❑ Any Auto
❑ All Owned Autos
Bed ly Injury Each Accident $ 100 000
® Scheduled Autos
05 XC5070 02 00
6/25/2008
6/25/2009
Property $
❑ Hired Auto
Damage 50 1
❑ Nonowned Autos
❑
Bad ly Injury and Property Damage Comb retl $ 000
Excess Liability
❑ Commercial Blanket Excess
Each 01 ire ce/Aggregate $ 000
❑
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I RESTRICTIONS I SPECIAL ITEMS t The Intl dual or partners shown as named ❑ Have ❑ He a not
elected to be cc a ad as employees under th s policy
t t Products Completed Operators egg agate is equal to each
occurrence I m t and Is included in pol cy aggregate
CERTIFICATE HOLDER S NAME AND ADDRESS
CANCELLATION
City of Fort Collins
Should any of the above described policies be cancelled before the
expiration date thereof the company will endeavor to mall ( 10 days)
PO Box 580
written notice to the Certificate Holder named but failure to mail such
Fort Collins CO 80522
notice shall impose no obligation or liability of any kind upon the
attn Purchasing Dept
company its agents or representatives 0 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
AUTHORIZE REPRESENTATIVE
9/8/2008
U 201 Ed 5/00 Certificate Holder Stock No 06668 Rev 7/02
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
Insureds Name and Address Agent s Name Address and Phone Number (Agt /Dist )
A & L Services LLC Daniel B Richmond (970) 484 2881
2329 W Mulberry St 923 E Prospect Rd
Fort Collins CO 80521 3224 Fort Collins CO 80525 1110 (005/316)
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
Th s s to cemfy that poi cas of so ance listed below he a been issued to the Insured named above for the pol cy period indicated notw thstand ng any requirement term or cord Lion of any contract or other
dor mart wth aspect to wh ch to s cent f cate may be as ad or may sale n the ins ranee alto ded by the poiic as best bed he ein is subject to all the terns exclusions and coned o s of such policies
TYPE OF INSURANCE
POLICY NUMBER
POLICY DATE
LIMITS OF LIABILITY
EFFECTIVE EXPIRATION
(Mo. Day. Yr Mo De Y
Homeowners/
Bodily Inj ry and Property Damage
Mobdehomeowners Liability
Each Occu a ce $ 000
BOalowners Liability
Bodily Injury and Property Damage
Each Occu re ce $ 000
Personal Umbrella Liability
Bodily In, ry and P clearly Damage
Each Occ rrence $ 000
Farm/Ranch Liability
Farm Lability & Personal L ab I ty,
$
Each Occur ante 000
Fa m Employers Liability
Each Occurrence $ 000
Workers Compensation and
Statutory , ., .,
Each Accident $ 000
Employers Liability t
D sease Each Employee $ 000
D sease Policy Limit $ 000
General Liability
Ge a at Agg agate 2000 000
_$
Products Completed Operaton$Aggregate $ 20000o0
® Commercial General
U
Liability
❑
05 XC5070 03 00
4/28/2008
4/28/2009
Personal and Ad arising Inu $ 1000 .000Each
Occurrence $ 1 000 000
❑
Damage to Premises Rented to You $ 100 000
Medical Expense (Any One Person) $ 5 0o0
Busmessowners Liability
Each Occurrencet t $ 000
Aggragatett $ 000
Liquor Liability
Common Cause Lim t $ 000
Aggregate L m t $ 000
Automobile Liability
Bodily Injury Each Person $ 50 000
❑ Any Auto
❑ All Owned Autos
Bed ly Injury Each Accident $ 100 000
® Scheduled Autos
05 XC5070 02 00
6/25/2008
6/25/2009
Property $
❑ Hired Auto
Damage 50 1
❑ Nonowned Autos
❑
Bad ly Injury and Property Damage Comb retl $ 000
Excess Liability
❑ Commercial Blanket Excess
Each 01 ire ce/Aggregate $ 000
❑
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I RESTRICTIONS I SPECIAL ITEMS t The Intl dual or partners shown as named ❑ Have ❑ He a not
elected to be cc a ad as employees under th s policy
t t Products Completed Operators egg agate is equal to each
occurrence I m t and Is included in pol cy aggregate
CERTIFICATE HOLDER S NAME AND ADDRESS
CANCELLATION
City of Fort Collins
Should any of the above described policies be cancelled before the
expiration date thereof the company will endeavor to mall ( 10 days)
PO Box 580
written notice to the Certificate Holder named but failure to mail such
Fort Collins CO 80522
notice shall impose no obligation or liability of any kind upon the
attn Purchasing Dept
company its agents or representatives 0 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
AUTHORIZE REPRESENTATIVE
9/8/2008
U 201 Ed 5/00 Certificate Holder Stock No 06668 Rev 7/02
25/092008 13 18 970 484-2945 Susan Clouse Page 22
CERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
Amencan 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 (Agl /Dist )
A & L Services LLC
2329 W Mulberry St
Fort Collins CO 80521 3224
Daniel B Richmond (970) 484 2881
923 E Prospect Rd
Fort Collins CO 80525 1110 (0051316)
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
The a to certify Met pol ass of reu ante I detl below h m he ea d In Me ns red named above for Ina poi cy p od od bated bona thmend ng my reel remenl, tam o mlMd on of my mblred a ohhe
do, marl with dap dl wb cb th ccM1fc in may be eeued or may perlam the memmce afforded by the Mnol w desmbed heron a mbjecl to all the tam, atol mom and condhone of a" polices
TYPEOFINSURANCE
POLICY NUMBER
POLICY DATE
LIMITS OF LIABILITY
FFFEMNE ExPIRATION
No. Da Y Moo Yr
Homeowners/
Bod lyI Ivy Ad MAY Dam g
Mobilehomeowners Liability
E Ao m ® $ 000
Boatowners Liability
add ly 1Nvy and P opedy Damage
Each 0mumence $ 000
Personal Umbrella Liability
god lyl Ivy ardP MAY Dam g
Each b $ 000
Ferm L abtVTP
lb Pa oral Uabhly
FarmlRanch Uabllity
Baca oce ma ce $ 000
Fam Employers L eh y
Each Occurrence $ 000
Workers Compensation and
s Who y .ww`
E ch Amite t $ 000
Employers Liability t
l Ea hEmpl y $ 000
U an Pal yLmI $ 000
General Liability
Genera Aggregate $ 2000 000
sum ds Compl lad Ope Mo a Agg egale $ 2000 000
® Commercial General
Pomb ha dM at an I u $ 1 00�
Liability (occurrence)
05 XC5070 03 00
4/28/2008
4/28/2009
Each O$ 1 000 000
¢urtance
❑
❑
Damage to Ran see Rested to You $ 100 000
M A cal Expense (My One Person) $ 5 000
Buslnessowners Liability
EachO ra cett $ 000
Aggragatett $ 000
Liquor Liability
Commo CaueaLmt $ 000
Aggregate Um $ 000
Automobile Liability
Bod lyI jury Eadr Pe am $ 000
❑ Any Auto
❑ All Owned Autos
Hddlylnlmy Eadh Acodent $ 000
❑ Scheduled Autos
$
❑ Hired Auto
Property Damage 000
NODOWned AUlOn
O
Bod ly l jury and P boil Damage combated $ 000
Excess Liability
❑ Commercial Blanket Fccess
E ch Owu encelAggegate $ 000
Other (Miscellaneous Coverages)
DESCRIP11014 OF OPEIRATONSILOCATIONS/ VEHII RESTRICTIMSISPECAM ITEMS tThe 6 dual p H how m marl ❑H a ❑Haw not
de M , I ygml
The commercial general liability policy is endorsed to include The City of
ROcledt.bamFlvaredelea
tt operator, aggregate to tl
Fort Collins as additional insured on the CIS 20 10 07 04 endorsement o, dote l mt and s nouded m Ml by aggregate
CERTIFICATE HOLDER S NAME AND ADDRESS
CANCELLATION
The Cityof Fort Collins
Should any cr the above described policies be cancelled before the
=cdon datathereof the company will endeavor to mail ( 30 days)
PO Box 580
written net. to the Cerkficate Holder named but failure to mail such
Fort Collins CO 80622
noLcppeaa shall impose no obligation or ItablNt�yy of any kind upon the
comberyof dayagents
geonttsrh or representatives f0 days unless different
Attn Purchasing Dept
❑ This call 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
MT
UTH IZD REPRESENTATIVE
0
1 cu.
U 201 Ed. 5100 Certificate Holder Stack No 06668 Rev 7/02
25/092008 13 18 970 484-2945 Susan Clouse Page 22
CERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
Amencan 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 (Agl /Dist )
A & L Services LLC
2329 W Mulberry St
Fort Collins CO 80521 3224
Daniel B Richmond (970) 484 2881
923 E Prospect Rd
Fort Collins CO 80525 1110 (0051316)
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
The a to certify Met pol ass of reu ante I detl below h m he ea d In Me ns red named above for Ina poi cy p od od bated bona thmend ng my reel remenl, tam o mlMd on of my mblred a ohhe
do, marl with dap dl wb cb th ccM1fc in may be eeued or may perlam the memmce afforded by the Mnol w desmbed heron a mbjecl to all the tam, atol mom and condhone of a" polices
TYPEOFINSURANCE
POLICY NUMBER
POLICY DATE
LIMITS OF LIABILITY
FFFEMNE ExPIRATION
No. Da Y Moo Yr
Homeowners/
Bod lyI Ivy Ad MAY Dam g
Mobilehomeowners Liability
E Ao m ® $ 000
Boatowners Liability
add ly 1Nvy and P opedy Damage
Each 0mumence $ 000
Personal Umbrella Liability
god lyl Ivy ardP MAY Dam g
Each b $ 000
Ferm L abtVTP
lb Pa oral Uabhly
FarmlRanch Uabllity
Baca oce ma ce $ 000
Fam Employers L eh y
Each Occurrence $ 000
Workers Compensation and
s Who y .ww`
E ch Amite t $ 000
Employers Liability t
l Ea hEmpl y $ 000
U an Pal yLmI $ 000
General Liability
Genera Aggregate $ 2000 000
sum ds Compl lad Ope Mo a Agg egale $ 2000 000
® Commercial General
Pomb ha dM at an I u $ 1 00�
Liability (occurrence)
05 XC5070 03 00
4/28/2008
4/28/2009
Each O$ 1 000 000
¢urtance
❑
❑
Damage to Ran see Rested to You $ 100 000
M A cal Expense (My One Person) $ 5 000
Buslnessowners Liability
EachO ra cett $ 000
Aggragatett $ 000
Liquor Liability
Commo CaueaLmt $ 000
Aggregate Um $ 000
Automobile Liability
Bod lyI jury Eadr Pe am $ 000
❑ Any Auto
❑ All Owned Autos
Hddlylnlmy Eadh Acodent $ 000
❑ Scheduled Autos
$
❑ Hired Auto
Property Damage 000
NODOWned AUlOn
O
Bod ly l jury and P boil Damage combated $ 000
Excess Liability
❑ Commercial Blanket Fccess
E ch Owu encelAggegate $ 000
Other (Miscellaneous Coverages)
DESCRIP11014 OF OPEIRATONSILOCATIONS/ VEHII RESTRICTIMSISPECAM ITEMS tThe 6 dual p H how m marl ❑H a ❑Haw not
de M , I ygml
The commercial general liability policy is endorsed to include The City of
ROcledt.bamFlvaredelea
tt operator, aggregate to tl
Fort Collins as additional insured on the CIS 20 10 07 04 endorsement o, dote l mt and s nouded m Ml by aggregate
CERTIFICATE HOLDER S NAME AND ADDRESS
CANCELLATION
The Cityof Fort Collins
Should any cr the above described policies be cancelled before the
=cdon datathereof the company will endeavor to mail ( 30 days)
PO Box 580
written net. to the Cerkficate Holder named but failure to mail such
Fort Collins CO 80622
noLcppeaa shall impose no obligation or ItablNt�yy of any kind upon the
comberyof dayagents
geonttsrh or representatives f0 days unless different
Attn Purchasing Dept
❑ This call 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
MT
UTH IZD REPRESENTATIVE
0
1 cu.
U 201 Ed. 5100 Certificate Holder Stack No 06668 Rev 7/02