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Home My WebLink AboutTHE JENSEN INVESTMENT GROUP LLC - INSURANCE CERTIFICATESHELTER SHELTER INSURANCE COMPANIES THIS POLICY ISSUED BY: SHELTER MUTUAL INSURANCE COMPANY NAME AND ADDRESS OF INSURED: THE JENSEN INVESTMENT GROUP LLC % MICHAEL JENSEN 1220 S COLLEGE AVE FORT COLLINS CO 80524-3716 GENERAL LIABILITY POLICY DECLARATIONS MANUAL DEC AGENT: LINDSAY MORALES STE C 220 W PROSPECT RD FORT COLLINS CO 80526 970-484-7505 05-E110-01 REISSUE OF POLICY NUMBER 05-31-3561297-3 THESE DECLARATIONS ARE A PART OF YOUR POLICY POLICY PERIOD: FROM 11:18 A.M. DECEMBER 4, 2009 TO JULY 8, 2010 AT 12:01 A.M. STANDARD TIME AT THE LOCATION OF THE PROPERTY DESCRIBED; AND SUBJECT TO CONSENT OF THE COMPANY FOR TERMS OF SUCH DURATION EACH THEREAFTER AS THE REQUIRED RENEWAL PREMIUM IS PAID BY THE INSURED AND RECEIVED BY THE COMPANY ON OR BEFORE EXPIRATION OF THE CURRENT TERM. _ LOCATION OF THE PREMISES COVERED IS: DEFINED POLICY TERRITORY OR SEE BELOW BUSINESS OF THE NAMED INSURED IS: DWELLINGS THE NAMED INSURED IS: OTHER AUDIT PERIOD: N/A SUBJECT TO THE TERMS OF THIS POLICY, THE COMPANY'S LIMITS OF LIABILITY FOR THE COVERAGES PROVIDED UNDER THIS POLICY ARE AS FOLLOWS: LIMITS OF INSURANCE GENERAL AGGREGATE (OTHER THAN PRODUCTS - COMPLETED OPERATIONS) $1,000,000 PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIMIT (SEE EACH CLASSIFICATION BELOW) INCLUDED PERSONAL AND ADVERTISING INJURY LIMIT $ 500,000 EACH OCCURRENCE LIMIT $ 500,000 DAMAGE TO PREMISES RENTED TO YOU LIMIT $ 100,000 ANY ONE PREMISES MEDICAL EXPENSE LIMIT $ 5,000 ANY ONE PERSON THE INSURANCE APPLIES ONLY WITH RESPECT TO THE FOLLOWING COVERAGE(S) AND THE HAZARD(S) SHOWN COVERAGE FORM AND DESCRIPTION OF HAZARDS PREMIUM BASES RATES �DVANCE PREMIUMS ANNUAL CG-00-01 COMPREHENSIVE GENERAL LIABILITY PREMISES & OPERATIONS- 63010 DWELLINGS - ONE FAMILY (LESSORS RISK ONLY) EACH 30.678 $31.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80524 1019 1/2 CLUB VIEW RD FORT COLLINS CO PREMISES & OPERATIONS- ; 60010 APARTMENT BUILDINGS UNITS 16.993 $136.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 8 ITEM ZIP CODE: 80524 813 SCOTT ST FORT COLLINS CO ' ***SEE CONTINUATION PAGE*** A POLICY CONSISTS OF THIS DECLARATION, COMMON POLICY CONDITIONS AND ONE OR MORE COVERAGE FORMS. A COVERAGE PART CONSISTS OF A COVERAGE FORM AND APPLICABLE ENDORSEMENTS. AMOUNT REFUNDED: $71.04 TRANSACTION: PC REF H.O. CODE: 725.00 POLICY TERM: ONE YEAR DATE ISSUED: 12-14-2009 '07102009' COVERAGE FOR ACTS OF TERRORISM IS INCLUDED IN YOUR POLICY AT NO CHARGE. 85% OF ANY LOSSES CAUSED BY CERTIFIED ACTS OF TERRORISM, IN EXCESS OF SHELTER'S DEDUCTIBLE, AND PAID BY SHELTER WOULD BE REIMBURSED BY THE UNITED STATES. THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A $100 BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS' LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES EXCEEDS $100 BILLION IN ANY ONE CALENDAR YEAR. ADDL INSURED: ADDL INSURED: DOWNTOWN DEVELOPMENT AUTHORITY CITY OF FORT COLLINS 19 OLD TOWN SQUARE STE 230 PO BOX 580 FORT COLLINS CO 80524-2471 FORT COLLINS CO 80522-0580 KE COUNTERSIGNED BY RICK MEANS G-2.8-G PAGE 1 1817 WEST BROADWAY • COLUMBIA, MISSOURI.65218-0001 9573-445-8441 SHELTER INSURANCE COMPANIES DECLARATIONS -CONTINUATION PAGE -POLICY NUMBER 05-31-3561297-3 INSURED: THE JENSEN INVESTMENT GROUP LLC MANUAL DEC AGENT: 05-E110-01 KE ISSUE DATE: 12-14-2009 ADVANCE PREMIUMS COVERAGE FORM AND DESCRIPTION OF HAZARDS PREMIUM BASES RATES ANNUAL PREMISES & OPERATIONS- ; 63010 DWELLINGS - ONE FAMILY (LESSORS RISK ONLY) EACH 30.678 31.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80549 3528 W CLEVELAND AVE WELLINGTON CO PREMISES & OPERATIONS- ; 63010 DWELLINGS - ONE FAMILY (LESSORS RISK ONLY) EACH 30.678 31.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80524 701 REMINGTON ST FORT COLLINS CO PREMISES & OPERATIONS- ; 63011 DWELLINGS - TWO FAMILY (LESSORS RISK ONLY) EACH 38.347 38.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80524 1019 CLUB VIEW RD FORT COLLINS CO PREMISES & OPERATIONS- ; 63013 DWELLINGS - FOUR FAMILY (LESSORS RISK ONLY) EACH 51.580 52.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80521 809 SCOTT AVE FORT COLLINS CO PREMISES & OPERATIONS- 63013 DWELLINGS - FOUR FAMILY (LESSORS RISK ONLY) EACH 51.580 52.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80524 1201 W PLUM ST FORT COLLINS CO PREMISES & OPERATIONS- 63010 DWELLINGS - ONE FAMILY (LESSORS RISK ONLY) EACH 30.678 31.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS. 1 ITEM ZIP CODE: 80524 1928 SPRINGFIELD DR FORT COLLINS CO PREMISES & OPERATIONS- 63010 DWELLINGS - ONE FAMILY (LESSORS RISK ONLY) EACH 30.678 31.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80524 404 E OAK ST FORT COLLINS CO PREMISES & OPERATIONS- 63010 DWELLINGS - ONE FAMILY (LESSORS RISK ONLY) EACH 30.678 31.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80521 1310 LAPORTE AVE FORT COLLINS CO PREMISES & OPERATIONS- 63010 DWELLINGS - ONE FAMILY (LESSORS RISK ONLY) EACH 30.678 31.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80524 704 REMINGTON ST FORT COLLINS CO PREMISES & OPERATIONS- ; 63010 DWELLINGS - ONE FAMILY (LESSORS RISK ONLY) EACH 30.678 31.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80524 414 PITKIN ST FORT COLLINS CO PREMISES & OPERATIONS- ; 63010 DWELLINGS - ONE FAMILY (LESSORS RISK ONLY) EACH 30.678 31.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80524 213 E VINE DR FORT COLLINS CO COVERAGE PARTS AND ENDORSEMENTS ATTACHED TO AND FORMING PART OF THIS POLICY: CG-00-01 (12-2007) COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG-21-67 (12-2004) FUNGI OR BACTERIA EXCLUSION CG-20-10 (07-2004) ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) DOWNTOWN DEVELOPMENT AUTHORITY G-146-G POLLUTION LIABILITY COVERAGE $100,000 IL-00-17 (11-1998) COMMON POLICY CONDITIONS CG-21-44 (07-1998) LIMITATION OF COVERAGE TO DESIGNATED PREMISES OR PROJECTS DESCRIBED PREMISES CG-21-60 (09-1998) EXCLUSION - YEAR 2000 COMPUTER -RELATED & ELECTRONIC PROBLEMS CG-20-10 (07-2004) ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) CITY OF FORT COLLINS IL-00-21 (09-2008) NUCLEAR ENERGY LIABILITY EXCLUSION (BROAD FORM) G-252-G AMENDATORY ENDORSEMENT CG-24-01 (12-2004) NON -BINDING ARBITRATION CG-21-47 (12-2007) EMPLOYMENT -RELATED PRACTICES EXCLUSION B-412-B PAGE 2 1817 WEST BROADWAY • COLUMBIA, MISSOURI � 65218-0001 •573-445-8441 (DECLARATIONS -CONTINUATION PAGE -POLICY NUMBER 05-31-3561297-3 INSURED: THE JENSEN INVESTMENT GROUP LLC MANUAL DEC AGENT: 05-E110-01 KE ISSUE DATE: 12-14-2009 COVERAGE PARTS AND ENDORSEMENTS ATTACHED TO AND FORMING PART OF THIS POLICY: B-601-B LEAD POISONING EXCLUSION ENDORSEMENT B-559-B ASBESTOS EXCLUSION CG-00-68 (05-2009) RECORDING AND DISTRIBUTION OF MATERIAL