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HomeMy WebLinkAboutTHE JENSEN INVESTMENT GROUP (MICHAEL JENSEN) - INSURANCE CERTIFICATE05-31-3561297-3 Policy Issued By j� Shelter 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 223 JEFFERSON ST STE B FORT COLLINS CO 80524-2431 These Declarations are part of your policy and replace all prior Declarations. ***MANUAL DEC*** General Liability Insurance Policy Declarations Agent: LINDSY MORALES 220 W PROSPECT RD STE C FORT COLLINS CO 80526 AGENT #: 05-E110-10 PHONE: 970-484-7505 Policy Number: 05-31-3561297-3 Effective Date: May 13, 2011, 12:01 A.M. Central Time Policy Form Number: CG 00 01 12 07 Expiration Date: July 8, 2011, 12:01 A.M. Central Time Business of the Named Insured: DWELLINGS Limits of Insurance_ General Aggregate (Other Than Products — Completed Operations) Products — Completed Operations Aggregate Limit (See Each Classification Below) Personal And Advertising Injury Limit Each Occurrence Limit Rented To You Limit Medical Expense Limit Description of Hazards PREMISES & OPERATIONS- 63013 DWELLINGS - FOUR FAMILY (LESSORS RISK ONLY) INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS ITEM ZIP CODE: 80524 1201 W PLUM ST FORT COLLINS CO PREMISES & OPERATIONS- 60010 APARTMENT BUILDINGS INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS ITEM ZIP CODE: 80524 813 SCOTT ST FORT COLLINS CO PREMISES & OPERATIONS- 63013 DWELLINGS - FOUR FAMILY (LESSORS RISK ONLY) INCLUDING PRODUCTS &/OR COMPLETED OPERATIONS ITEM ZIP CODE: 80521 809 SCOTT AVE FORT COLLINS CO Additional information on next page (For Office Use Only) Transaction: P.C. H.O. CODE: 300.00 Policy Term: One Year Date Issued: 05-16-2011 '01202011' The Named Insured is a(n): Corporation Audit Period: N/A Premium Bases EACH 1 UNITS 8 EACH 1 Countersigned By $1,000,000 Included $500,000 $500,000 $100,000 Any One Premises $5,000 Any One Person Rates Advance (Annual) Premium 49.926 $50.00 16.391 $131.00 49.926 $50.00 gl G-2.9-G Page 1 05-31-3561297-3 Premium Adjusting Endorsements Pollution Liability Coverage Limits 100,000 Total For Term (This Is Not A Bill): Endorsement Advance Number Premium G-146-B $23.00 $300.00 Other Endorsements Attached To This Policy. _ Endorsement Number Fungi Or Bacteria Exclusion CG 21 67 12 04 Addl Insured -Owners, Lessees Or Contractors-Sched Person Or Org DOWNTOWN DEVELOPMENT CG 32 29 06 10 Authority Addl Insured -Owners, Lessees Or Contractors-Sched Person Or Org City Of Fort Collins Colorado Changes- Cancellation And Nonrenewal Common Policy Conditions Limitation Of Coverage To Designated Premises Or Projects Described Premises Exclusion - Year 2000 Computer -Related & Electronic Problems Nuclear Energy Liability Exclusion Endorsement Amendatory Endorsement (Pollution Exclusion) Non -Binding Arbitration Employment Related Practices Exclusion Asbestos Exclusion Rec & Dist Of Material Or Info In Violation Of Law Exclusion 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 CG 32 29 06 10 IL02280907 IL 00 17 11 98 CG 21 44 07 98 CG 21 60 09 98 IL 00 21 09 08 G-252-G CG24011204 B-601-B B-559-B CG 00 68 05 09 gl G-2.9-G Page 2