HomeMy WebLinkAboutMICHAEL FELTZ SR - 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.)
Michael Feltz Sr 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
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 IhiS 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
D
LIMITS OF LIABILITY
EFFECTIVE XRRATION
Mo. Dd Vr Mo Day, Yr
Homeowners/
Bodily Injury and Property Damage
Mobilehomeowners Liability
Each occurrence $ ,000
Boatowners Liability
Bodily Injury and Properly Damage
Each Occurrence $ '000
Personal Umbrella Liability
Bodily Injury and Property Damage
Each Occurrence $ ,000
Farm/Ranch Liability
Farm Liability & Personal LiaUiliry
Each Occurrence $ ,000
Farm Employer's Llablllty
Each Occurrence $ 000
Workers Compensation and
Statutory
Employers Liability t
Eaa, Accident $ ,000
Disease - Each Employee $ .000
Disease Policy Limit $ ,000
General Liability
General Aggregate $ 2,000 000
® Commercial General
Products- Completed operations Aggregate $ 2.000 ,000
Liability (Occurrence)
❑
05-XC5070-03-00
4/28/2008
4/28/2009
Personal and Advertising Inu $ 1,000
Each Occurrence $ 1,000 ,000
❑
Damage to 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 $ 50 ,000
❑ Any Auto
❑ All Owned Autos
Bodily Injury- Each Accident $ 100 ,00c
® Scheduled Autos
05-XC5070-02-00
6/25/2008
6/25/2009
Property $
❑ Hired Auto
Damage 50 ,000
❑ Nonowned Autos
❑
Bodily Injury and Properly Damage Combined $ .000
Excess Liability
❑ Commercial Blanket Excess
Each Occurrence/Aggregate $ 000
❑
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS / LOCATIONS /VEhIICLES/RES1 RICTIONS/SPECIAL ITEMS tThe individual or partners shown as insured ❑Have ❑Have not
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.
CERTIFICATE HOLDER'S NAME AND ADDRESS
CANCELLATION
• CityOf Fort Collins - Purchasing Dept
9 p
Should any of the above described policies be cancelled before the
expiration date thereof, the company will endeavor to 10 days)
P O Box 580
mail'(
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
its '10
company, agents or representatives. 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
EPRESENTATIVE
2/9/2009
VA
-
M1
U-201 Ed. 5100 Certificate Holder