HomeMy WebLinkAbout223028 THE FAMILY CARE CONNECTION INC - INSURANCE CERTIFICATEA SCOTTSDALE INSURANCE COMPANYt9
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SUPPLEMENTAL DECLARATIONS
Policy No. CLS1337564 Effective Date 02/14/2007
12:01 A.M., Standard Time
Named Insured FAMILY CARE CONNECTION, INC. Agent No.
Item 1. Limits of Insurance
Coverage
Limit of Liability
Aggregate Limits of Liability
Products/Completed
$ 1,000,000
Operations Aggregate
General Aggregate (other than
$ 1,000,000
Products/Completed Operations)
Coverage A - Bodily Injury and
any one occurrence subject
Property Damage Liability
to the Products/Completed
Operations and General
$ 1,000,000
Aggregate Limits of Liability
any one premises subject to the
Coverage A occurrence and
the General Aggregate Limits
Damage to Premises Rented to You Limit
$ 100,000
of Liability
Coverage B - Personal and
any one person or organization
Advertising Injury Liability
subject to the General Aggregate
$ 1,000,000
Limits of Liability
Coverage C - Medical Payments
any one person subject to the
Coverage A occurrence and
$ 5,000
the General Aggregate Limits
Item 2. Description of Business -- -_
-
Form of Business:
❑ Individual ❑ Partnership ❑ Joint Venture ❑ Trust
❑ Limited Liability Company
® Organization including a corporation (other than Partnership, Joint Venture or Limited Liability Company)
Location of All Premises You Own, Rent or Occupy:
2521 BEDFORD COURT, FORT COLLINS , CO 8OS26
Item 3. Forms and Endorsements
Form(s) and Endorsement(s) made a part of this policy at time of issue:
See Schedule of Forms and Endorsements
Item 4.
Coverage Part Premium:
$ 3,025
Other Premium:
Total Premium:
___$ 3,025
THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE iNSURED AND
'-IE POLICY PERIOD.
CLS-SD-1 L (8-01) INSURED clssdlle. fap
POLICY NUMBER: CLS1337564
COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(s)
Or Ciamzation s Locations of Covered Operations
CITY OF FORT COLLINS-PURCHASING DIVISION ALL JOBS PERFORMED BY FAMILY CARE
P.O. BOX 580 CONNECTION, INC.
FORT COLLINS, CO 80522
Information required to complete this Schedule if not shown above will be shown in the Declarations.
A. Section II - Who is An Insured is amended to in-
clude as an additional insured the person(s) or or-
ganizations) shown in the Schedule, but only with
respect to liability for "bodily injury", "property dam-
age" or "personal and advertising injury" caused, in
whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s) desig-
nated above.
B. With respect to the insurance afforded to these ad-
ditional insureds, the following additional exclu-
sions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or equip-
ment furnished in connection with such work,
on the project (other than service, mainte.
nance or repairs) to be performed by or on be-
half of the additional insured(s) at the location
of the covered operations has been com-
pleted; or
2. That portion of "your work" out of which the in-
jury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a princi-
pal as a part of the same project.
CG 20 10 07 04 Copyright, ISO Properties, Inc., 2004 Page 1 of 1
INSURED