HomeMy WebLinkAboutERAMIRO LOPEX CRISTAL ROOFING - 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
Insureds Name and Address
Ramiro Lopez DBA Cristal s Roofing
2100 Ideal Lane
Fort Collins CO 80524
Agents Name Address and Phone Number (Agt /Dist )
Daniel B Richmond (970) 484 2881
923 E Prospect Rd
Fort Collins CO 80525 1110 (125/309)
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 carry, that policies of Insurance listed below he a been issued to the insured named above for the policy pence Indicated notw thstanding any requirement term or condition of any contract or other
document with respect to win on this certificate may be issued or may pertain the Insurance afforded by the Policies described harem is subject to all the terms exclusions and conch ons of such polio as
TYPE OF INSURANCE
POLICY NUMBER
POLICY DATE
LIMITS OF LIABILITY
EFFECTIVE EXPIRATION
(Mo. Da Yet Mo. Da 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
Liability B Personal Liabll ty
Farm/Ranch Liability
$
Each Occurrence 000
Each
Farm Employers Liability
Each Occurrence $ 000
Workers Compensation and
Statutory
Each Accident $ 000
Employers Liability t
Disease Each Employee $ 000
casette Policy Limit $ 000
General Liability
General Aggregate $ 2000,000
Products Completed 0eralonsA r ate $ 2000 000
® Commercial General
Liability(occurrence)
p
05 X95948 01 00
9/82004
9/8/2005
Personal and AdvertisingInu $ 1000
Each Occurrence $ 1 000 000
❑
Damage to Premises Reefed to You $ 100 000
Medical Expense (Any One Person) $ 5 000
Businessowners Liability
Each Occurincet t $ 000
Aggagatett $ 000
Liquor Liability
Common Cause Limit $ 000
Aggregate Limit $ 000
Automobile Liability
Badly Injury Each Person $ 000
❑ Any Auto
❑ All Owned Autos
Badly Injury Each Accident $ 000
❑ Scheduled Autos
Property Damage $
❑ Hired Auto
000
❑ Nonowned Autos
❑
Bod ly 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 mdMldual or partners shown as insured ❑ Have ❑ Have not
/ i
// F
(/� f i i f� i r i elected to be covered as employees under this policy
tt Products Completed Operations aggregate Is equal to each
occurrence limit and is included In policy aggregate
CERTWWAU HOWER S NAME ANDADDRESS
CANCELLATION
Should any of the above described policies be cancelled before the
expiration date thereof the company wdl endeavor to mad ( 10 days)
City of Fort Collins
written noses to the Certificate Holder named but failure to mad such
P O Box 580
notice shall impose no obligation or liability of any kind upon the
or representatives 10 days unless different
umberiof days
Fort Collins CO 80522
shown
1224 6134
❑ This certifies coverage on the date of issue only The above
described policies are subject to cancellation in conformity with their
py
terns and the laws of the state of issue
DATE ISSUED
A O EPRE ENTATIVE
9/8/2004
U 201 Ed 5/00 Certificate Holder 4 _ ` Stock No 06668 Rev 7102