HomeMy WebLinkAbout460393 JARED WASHAM - INSURANCE CERTIFICATE (2)07/07/2009 06:10 FAX 970 686 6181 State Farm fa001
Certificate of Insurance
This certifies that State Farm Fire and Casualty Company, Bloomington, Illinois
State Farm General Insurance Company, Bloomington, Illinois
State Farm Fire and Casualty Company, Aurora, Ontario
�..w.� State Farm Florida Insurance Company, Winter Haven, Florida
State Farm Lloyds, Dallas, Texas
Insures the following policyholder for the coverages indicated below:
Policyholder Jared Washam
Address of policyholder 2008 W Lake Street Fort Collins, CO 80521
Location of operations 2008 W Lake Street Fort Collins, CO 80521
Description of operations Artistry
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.
Policy Period
Limits of Liability
Poliq Number
Type of Insurance
Effective Date i Expiration Date
at beginning of policy period
Comprehensive
BODILY INJURY AND
Pending
Business Liability 07/07/2009 07/07/2010
PROPERTY DAMAGE
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This insurance includes:
-----------------------:-.-....-.-.-.-....-......
Products - Completed Operations
Contractual Liability
Each Occurrence $ 1,000,000.00
Personal Injury
Advertising Injury
General Aggregate $
Product -Completed $
Operations Aggregate
Policy Period
BODILY INJURY AND PROPERTY DAMAGE
Po(i2y Number
EXCESS LIABILITY
Effective Date Expiration Date
Combined Single Limit)
❑ Umbrella
Each Occurrence $
❑ Other
Aciptpegate $
Policy Period
Effective Date i Expiration Date
Part I - Workers Compensation - Statutory
Workers' Compensation
Part II -Employers Liability
and Employers Liability
Each Accident $
Disease - Each Employee $
Disease - Policy Limit $
Policy Period
Limits of Liability
Policy Number
Type of Insurance
Effective Date i Expiration Date
at beginning of policy period
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
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
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 mall such notice, no
obligation or liability will be imposed on State Farm or
its ag nts or representatives.
Signature of Authorized Representative
Agent 7/07/2009
Title Date
Scott Horvath
Agent Name
Telephone Number 686-6161
Agent's Code Stamp
AgentCode
AFO Cotle
1001280
106398.8 03-18.2009