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Home My WebLink About273314 THE JENSEN INVESTMENT GROUP - INSURANCE CERTIFICATE (2)05-31-3561297-3 Policy Issued By WShelter Mutual Insurance Co. 1817 W Broadway Columbia, MO 65218-0001 1-800-SHELTER, 1-800-743-5837 Named Insured: THE JENSEN INVESTMENT GROUP % MICHAEL JENSEN 1220 S COLLEGE AVE FORT COLLINS CO 80524-3716 Notice to the Mortgagee/Loss Payee/Addl Insured: Your interest will be continuous until cancellation notice is mailed to you. ***MANUAL DEC*** General Liability Insurance Policy Declarations Agent: LINDSAY MORALES 220 W PROSPECT RD STE C FORT COLLINS CO 80526 AGENT #: 05-E110-01 PHONE: 970-484-7505 Policy Number: 05-31-3561297-3 Effective Date: December 15, 2010, 12:01 A.M. Central Time Policy Form Number: CG 00 01 12 07 Expiration Date: July 08, 2011, 12:01 A.M. Central Time Business of the Named Insured: DWELLINGS The Named Insured is a(n): Corporation Audit Period: N/A 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 Rented To You Limit $100,000 Any One Premises Medical Expense Limit $5,000 Any Orie Person Description of Hazards Premium Bases _ Rates Advance .. _...._ (Annual) - Premium PREMISES & OPERATIONS- 63010 DWELLINGS - ONE FAMILY (LESSORS RISK ONLY) EACH 29.624 $30.00 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 16.391 $131.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 8 ITEM ZIP CODE: 80524 813 SCOTT ST FORT COLLINS CO PREMISES & OPERATIONS- 63011 DWELLINGS - TWO FAMILY (LESSORS RISK ONLY) EACH 36.992 $37.00 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS 1 ITEM ZIP CODE: 80524 1019 CLUB VIEW RD FORT COLLINS CO PREMISES & OPERATIONS- 63013 DWELLINGS - EACH 49.926 $50.00 FOUR FAMILY (LESSORS RISK ONLY) 1 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS ITEM ZIP CODE: 80521 809 SCOTT AVE FORT COLLINS CO PREMISES & OPERATIONS- 63013 DWELLINGS - EACH 49.926 $50.00 FOUR FAMILY (LESSORS RISK ONLY) 1 INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS ITEM ZIP CODE: 80524 1201 W PLUM ST FORT COLLINS CO Additional information on next page (For Office Use Only) Transaction: PC REF H.O. CODE: 388.00 Policy Term: One Year Date Issued: 01-05-2011 "2012010' Countersigned By gl G-2.9-G Page 1 05-31-3561297-3 Premium Adjusting, Endorsements Additional Insured - Owners, Lessees or Contractors (Form B) DOWNTOWN DEVELOPMENT AUTHORITY Pollution Liability Coverage Additional Insured - Owners, Lessees or Contractors (Form B) CITY OF FORT COLLINS t Limits Endorsement Advance Number Premium CG 20 10 07 04 $30.00 100,000 G-146-G $30.00 CG 20 10 07 04 $30.00 Total For Term (This Is Not A Bill): $388.00 Other Endorsement's Attached To This _Pohcy_ 1 __, _ Fungi Or Bacteria Exclusion CG 21 67 12 04 Colorado Changes - Cancellation And Nonrenew IL 02 28 09 07 Common Policy Conditions IL 00 17 11 98 Limitation Of Coverage To Designated Premises Or Projects Described Premises CG 21 44 07 98 Exclusion - Year 2000 Computer -Related & Electronic Problems CG 21 60 09 98 Nuclear Energy Liability Exclusion (Broad Form) IL 00 21 09 08 Amendatory Endorsement G-252-G Non -Binding Arbitration CG 24 01 12 04 Employment -Related Practices Exclusion CG 21 47 12 07 Lead Poisoning Exclusion Endorsement B-601-B Asbestos Exclusion B-559-B Rec & Dist Of Material Or Info In Violation Of Law Exclusion CG 00 68 05 09 ADDL INSURED: DOWNTOWN DEVELOPMENT AUTHORITY 19 OLD TOWN SQUARE STE 230 FORT COLLINS CO 80524-2471 ADDL INSURED: CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 gl G-2.9-G Page 2