HomeMy WebLinkAboutKEN, LINDA & BRIAN FISHER - INSURANCE CERTIFICATE (2)OP ID: DS
ACOKO'
CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD/YYYY)
10/20/11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsements .
PRODUCER 970-867-8246"
Goetz Insurors, Inc. 970-867�408
227 Main St •-
Fort Morgan, CO 80701 -
g
Tracy A. Parachini
1� O�
CONTACT - '
PHONE FAX
AlG No Ezt: A/C No:
ABDRESS:
PRODUCE"
R Du E FISH-KE
CUSTOMERIDd:
INSURERS AFFORDING COVERAGE
NAIC N
INSURED Ken, Linda & Brian Fisher
Kenlyn Stables, Inc
4916 Bingham Hill Rd
Fort Collins, CO 80521-1073
INSURERA:American Bankers Insurance Co
INSURER B:
INSURERC:
INSURER D
INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
L R
TYPE OF INSURANCE
POLICY NUMBER
MMIOD�
POLICY
YVPY
LIMITS
GENERAL LIABILITY
X COMMERCIALGENERAL LIABILITY
CLAIMS -MADE Fx I OCCUR
X
FSL4160697
11/20/11
11/20/12
EACH OCCURRENCE
$ 1,000,00
PREMISES E.eccunence
$ 60,00
MED EXP (Any one person)
$ 5,00
PERSONAL B ADV INJURY
$ 1,000,00
GENERALAGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
PRODUCTS - COMP/OP AGG
$ 2,000,00
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OVMED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
—
.
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per parson)
$
BODILY INJURY (Peremitlenq
$
PROPERTY DAMAGE
(Peraccident)
$
$
$
UMBRELLA LIAR
EXCESS LIAB
HOCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION E
$
$
WORKERSCOMPENSA71ON
AND EMPLOYERS'LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
I
WC STATU- OTH-
E.L. EACH ACCIDENT
$
E. L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
b
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AUach ACORD 101, Addltlonal Remarks Schedule, If more space is required)
Certificate holder is additional insured in respect to hay operation.
Additional insured includes The City, its officers, agents and employees.
FTCOLLI
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
The City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Purchasing Department ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIyE`
Tracy A. Parachini 1 t
01988-2009 ACORD CORTTION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD