HomeMy WebLinkAboutROGER JIMENEZ - 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 Agents Name Address and Phone Number (Agt /Dist )
Roger Jimenez Ryan Slaughter (303)444 1009
1001 Gregory Rd 2529 Broadway St
Fort Collins CO 80524 Boulder CO 80304 4110 (080/311)
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
Time is to can fy that policies of nsurance I also below have been issued to the insured named above for the policy peroor indicated now thstanding any requirement tens 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 pot cies described herein a subject to all the terms exclusions and cond bons of such policies
TYPE OF INSURANCE
POLICY NUMBER
POLICY DATE
LIMITS OF LIABILITY
EFFECTIVE EXPIRATION
Mo Da Yr Mo Day, Yr
Homeowners/
Bod ly Inlury entl Property Damage
Mobdehomeowners 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/Ranch Liability
Farm Liability 8 Personal Liability
Each Occurrence $ 000
Farm Employers Liability
Workers Compensation and
Employers Liability t
#4103276
10/24/2007
10/24/2008
Each Occurrence $ 000
statutory
Each Accident $ 100 000
D sease Each Employee $ 100 000
Disease Pohry Llmt $ 500 000
General Liability
❑ Commercial General
Liability (occurrence)$
❑
05XM749301
7/20/2008
7/20/2009
General Aggregate $ 2000 000
Products Completed Operations Aggregate $ 2 000 000
re 500
Peonaiand aavenisln inu 000
Each Occurrence $ 500 0oo
❑
Dame a to Premises Rented to You $ 25 000
Medical Ex ense (Any One Parson) $ 5 O00
Businessowners Liability
Each Occurrencet t $ 000
Aggregatett $ 000
Liquor Liability
Common Cause Lim t $ 004
Automobile Liability
❑ Any Auto
Aggregate L ned $ 000
Bodily Injury Each Person $ 1 000 000
❑ All Owned Autos
❑ Scheduled Autos
❑ hired Auto
❑ Nonowned Autos
05XZ703601
10/24/2007
10/24/2008
Bodily Injury Each Accident $ 1 000 000
Property Damage $ 1 000 000
Bodily Injury and Property Damage Combined $ 1 000 000
❑
Excess Liability
OCommercial Blanket Excess
11
Each occurrence/Aggregate
$ 000
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS /SPECIAL ITEMS
t The individual or partners shown as I ❑ Insured Have ❑ Have not
j elected atl to to be covered as employees antler this poi cY
u
t t Products Completed Operations aggregate Is equal to each
occurrence limit and Is included In policy aggregate
CERTIFICATE HOLDERS NAME AND ADORES S
CANCELLATION
City of Fort Collins
Purchasing &Risk Management
215 N Mason St 2nd Floor
Fort Collins CO 80524
Should any of the above described policies be cancelled before the
expiration date thereof the company wAI 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 agents or representatives 10 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
AUTHORIZED REPRESENTATIVE
7/21/2008
Julia Schwarzkopf
U 201 Ed 5/00 Certificate Holder Stock No 06668 Rev 7/02