HomeMy WebLinkAboutMICHAEL FELTZ - INSURANCE CERTIFICATE08/04/2009 14:36 970-484-2945 Cheryl Page 22
CERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company if selection box is not checked.
6000 American Pry Madison, Wisconsin 53783-0001
Insured's Name and Address Agent's Name, Address and Phone Number (Al
Michael Feltz Sr
2329 W Mulberry St
Fort Collins, CO 80521-3224
Daniel B Richmond (970) 484-2881
923 E. Prospect Rd
Fort Collins, CO 80526-1110 (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
The is to mrlify, that policies of insurance Lord Wlmv have base sseed to the insured named above for has poesy period indicated, noivrAirshe ding any mW immied Icon or condition of any conbacl u erner
dro man) Mh impact le More His cortical. may be i66lled as may g9the, he Ireame or, erolded by my perisms described Itel&n Is col ieLl to all the terms, exclusion , and color lion of reach (laliGes.
TYPE OF INSURANCE
POLICY NUMBER
POLICY DATE
LIMITS OF LIABILITY
EFFECTIVE EAPIRATION
Bob,Cry. Yr(Ma. Des. Yr
Homeowners)
Evil local, aid recalls Damage
Mobilehomeowners Liability
Ed, 0.eonra $ '000
Boatowners Liability
Bodily hill red! Porosity Dan age
Each Ocwuence $ ,000
Personal Umbrella Liability
Easily hoary and Library Damage
Each Coeimence $ .000
Form Liability & Fill usible,
Farm/Ranch Liability
Each Occurrence $ '000
Form Employer' a Lr ill,
Each occurrence $ 000
Workers Compensation and
slannon
Each Acvidenl $ ,000
Employers Liability t
Dlseess - Each Emplayee $ '000
ITsease. Policy Lmol $ '000
General Liability
Goosed.' Aggregate $ 2,000 000
Ploduda- Ccmpleled Operations Aggragdo $ 2,000 ,000
® Commercial Genera)
Liability (occurrence)
El05-XC5070-03-00
4/28/2009
4128/2010
Pehsma'and Auverlieog rase,, $ 1,000 Coo
Each Occurrence $ 1.000 ,000
❑
overcome to Premises Retied to You $ 100 000
Medical Freer ov, One Perawh) $ 5 00o
Businessowners Liability
Each Occurrenvat t $ '000
Aggregalntt $ '000
Liquor Liability
Common Causelimil $ '000
Aggregate Limit $ '000
Automobile Liability
BoNrylnjury-Eadh Persen $ 50 ,000
❑ Any Auto
❑ All Owned Autos
Bodily miiry. Ends Accident $ 100 ,000
® Scheduled Autos
05-XC5070-02-00
6/25/2009
6/25/2010
$
❑ Hired Auto
Prglerly Damage 50 ,000
❑ Nonowned Autos
❑
Bodily lnlwy antl Pmpe,ly Damage ComFxred $ 000
Excess Liability
❑ Commercial Blanket Excess
Each OrraeecerAggegale $ '000
Other (Miscellaneous Coveranesl
DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICi IRESTRICTIONS I SPECIAL ITEMS tTheindndualorpadnerssho nasmsund []Have ❑Havenol
elected to be coveria ale employees Under this policy.
tt ProdudsApmassed Olosralires aggregele is ague) to each
OcNmenes [,art mi boodad m rl alrg,egale.
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 mail `( 10 days)
P O Box 580
written notice to the Certificate Holder named, but failure to mail such
Fort Collins Cc 80522
notice shall impose no obligation or liabilit of any kind upon the
'1y0
company, its 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.
DATFI. UEU
AUTHORIZED RFP .SENT. Iry
08/04/2009
U•201 Ed. 5100 Stock No. 06668 Rev. 7/02