HomeMy WebLinkAbout460393 JARED WASHAM - INSURANCE CERTIFICATE07/07/2009 06:10 FAX 970 686 6181 State Farm
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Certificate of Insurance
This certifies that State Farm Fire and Casualty Company, Bloomington, Illinois
State Farm General Insurance Company, Bloomirigton;-Illinei
State Farm Fire and Casualty Company au o a;�ontar'o 1�
State Farm Florida Insurance Co an,y, tWnter Haven, Florid
State Farm Lloyds, Dallas, Texast n I � E `U, '
Insures the following policyholder for the coverages indicated below:
Policyholder Jared Washam
Address of policyholder
Location of operations
Description of operations
W Lake Street
2008 W Lake Street Fort Collins, CO 80521 ►�Y
Artistry
JUL 9
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
Poliq Number
Type of Insurance
Policy Period
Effective Date Expiration Date
Limits of Liability
at beginning of policy periodl
Comprehensive
BODILY INJURY AND
Pending
- --- - -- - -
This insurance includes:
Business Liability 0710712009--n---•--07107/201
Products - Completed 0 e Liability atians 1
- - - - - `� V U .
Contractual
Personal Injury
1 ry
Advertising Injury OCT 5 2009
PROPERTY DAMAGE
Each Occurrence $ 1,000,000.00
General Aggregate $
Product - Completed $
Hv
Operations Aggregate
Policy -Period
BODILY INJURY AND PROPERTY DAMAGE
Poligr Number
EXCESS LIABILITY
Effective Date Expiration Date
Combined Sin le Limit)
❑ umbrella
Each Occurrence $
❑ Other
A re ate $
Policy Period
Effective Date Expiration Date
Part I - Workers Compensation - Statutory
Workers' Compensation
Part II - Employers Liability
and Employers Liability
Each Accident $
Disease - Each Employee $
i
Disease - Policy Limit $
Policy Number
Type of Insurance
Policy Period
Effective Date Expiration Date
Limits of Liability
at beginning of policy period
THE CERTIFICATE OF
INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER
AFFIRMATIVELY NOR NEDAirlVFLY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
Name and Address of Certification Holder
City of Fort Collins
Purchasing Dept
215 N College
Fort Collins, CO 80521
Fax 970-221-6707
L�C��I.�nfl ,
NOV - 5 2009
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If any of the described policies are canceled before
their expiration date, State Farm will try to mail a
written notice to the certificate holder 30 days
before cancellation. if we fail to mail such notice, no
obligation or liability will be imposed on State Farm or
its ag$nts or representatives.
Signature ofAuthorized Representative
Agent 7/07/2009
Title Date
Scott Horvath
Agent Name
Telephone Number 68$-6161
Agent's Code stamp
Agent Code
AFO Code
1001260 106399.9 0316.2009