HomeMy WebLinkAbout451762 DAVID TALBOT - INSURANCE CERTIFICATER� INSURANCE BINDER OP ID c>K D09/30/ 0 9
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THI
AGENCY
COMPANY
BINDER# 10914
TheTravelers
Six S Geving Insurance, Inc.
DATE EFFECTIVE TIME
DATEEXPIRATION TIME
3630 Sinton Road, Suite 200
X
X
12:01 AM
Colorado Springs CO 80907-5034
AM
David B. Reitan
10/O1/09
12:01
PM
10/31/09
NOON
(A/C, No, Ext): 719-590-9990 (A/C, No): 719-590-9992
THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY
PER EXPIRING POLICY it 680-0886P572
CODE: 76D4L SUB CODE:
AGENCY
CUSTOMER ID: TALBO-1
DESCRIPTION OF OPERATIONSIVEHICLES/PROPERTY (Including Location)
Location: 01 Building: 01
INSURED
30 day binder pendingg issuance of policy.
10/l/09-10/1/10
Policy period
Dave Talbot
2420 Rossmere Street
Colorado Springs CO 80919
COVERAGES LIMITS
TYPE OF INSURANCE
COVERAGEIFORMS
DEDUCTIBLE
COINS %
AMOUNT
PROPERTY CAUSES OF LOSS
BASIC BROAD ❑X SPEC
X Replacement Cost
CONTENTS
Soo
90
10000
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
REMO DATE FOR CLAIMS MADE:
EACH OCCURRENCE
$ 1000000
X
DAMAGFTO
RENTED PREMISES
$300000
MED EXP (Any one person)
$ 5000
PERSONAL & ADV INJURY
$1000000
GENERAL AGGREGATE
$2000000
PRODUCTS - COMP/OP AGG
$ 2000000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
$
BODILY INJURY (Per person)
$
�-
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
$ Y
MEDICAL PAYMENTS
$
PERSONAL INJURY PROT
$
UNINSURED MOTORIST
$
AUTO PHYSICAL DAMAGE DEDUCTIBLE
COLLISION: _
` OTHER THAN COL:
ALL VEHICLES SCHEDULED VEHICLES
ACTUAL CASH VALUE
$
STATED AMOUNT
OTHER
GARAGE LIABILITY
ANY AUTO
AUTO ONLY- EA ACCIDENT
$
OTHER THAN AUTO ONLY:
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
RETRO DATE FOR CLAIMS MADE:
EACH OCCURRENCE
$
AGGREGATE
$
SELF -INSURED RETENTION
$
WORKER'S COMPENSATION
AND
EMPLOYER'S LIABILITY
-
WC STATUTORY LIMITS
E.L- EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$ '
SPECIAL Annual Premium direct billed by Travlers
CONDITIONS/
IONSf
COVERAGES
FEES
$
TAXES
$
ESTIMATED TOTAL PREMIUM
$ $50U • OO
NAME & ADDRESS
--
MORTGAGEE
LOSS PAYEE
ADDITIONAL INSURED
LOAN #
AUTHORVECESENTATN�E
ACORD 75 (2004/09) NOTE: IMPORTANT STATE INFORMATION ON REVERSE SIDE ACORD CORPORATION 1993-20C