HomeMy WebLinkAbout357006 ALL AMERICAN BACKFLOW - INSURANCE CERTIFICATE (6)®
A`I CERTIFICATE OF LIABILITY INSURANCE
DATEIMMIDDNYYY)
05-12-2012
THIS CERTIFICATEIS 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 SUBROGATIONIS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statementon this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCED
LEID FINANCIAL GROUP INC/PHS
CONTACT
NAME
A/C No E,d. (866) 467-8730 (AIG, Nor. (877) 905-045
342560 P:(866)467-8730 F:(877)905-0457
9 MAIL
PO BOX 33015
ADDRESS
VHUOUGLH
SAN ANTONIO TX 78265
CUSTOMERID k:
INSURERISI AFFORDING COVERAGE NAIC k
INSURED -I
O
INSURERA: Hartford Casualty Ins CO
INSURER B
LYNNETTE KEIM DBA ALL AMERICAN BACKFLOW
215 E 2ND ST
INSURER C
LOVELAND CO 80537
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.
IPOLICY
N
TYPE OF INSURANCE
INSRWVD
POLICY NUMBER
EFF
IMMIDDIYYYY)
POLICY ENT
(MMIDD/YYYY)
LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE II OCCUR
X1 General Liab
X
34 SBA PE5367
05/26/2012
05/2 6/2 013
EACH OCCURRENCE
5 1, O O O 000
PREMISES IEa ocwrrencel
S 300, OOO
MED EXPIA, one person)
S 10, 000
PERSONAL BADVINJURY
$ 1,000,000
GENERAL AGGREGATE
s 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY �I PRO X
C LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
IEs e.odsnfl
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per acdd,ndl
S -
PROPERTY DAMAGE
(Per accident)
S
$
5
UMBRELLA LIAR I OCCUR
EXCESS LIAR CLAIMS -MADE
EACH OCCURRENCE
$
I AGGREGATE
I S
DEDUCTIBLE
RETENTION $
S
5
WORKERS COMPENSATION
AND Eh1T DYERS' LIABILITY
ANY PROPRIETORIPARTNERiEXECUTIVE—
OFFICER/MEMBER
IMend.m,, in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
IM
TORY LIMITS N I OER
E.L. EACH ACCIDENT
s
E.L. DISEASE - EA EMPLOYEEI
$
E.L. DISEASE -POLICY II MIT
I S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IADach ACORD 101. Additi,nel Remark, Schedule, If more spec. Is ieRuired)
Those usual to the Insured's Operations. City of Fort Collins are Additional
Insured per the Business Liability Coverage Form SS0008.
City of Fort Collins
215 N MASON ST
FORT COLLINS, CO 80524
UAIN U CLLM I I V IN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
AUTHORIZE UPRIESENTATIVE `
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD