HomeMy WebLinkAboutKEN LINDA & BRIAN FISHER - INSURANCE CERTIFICATEOP ID: TP
A`. o CERTIFICATE OF LIABILITY INSURANCE
OAT04119DIYYVY)
4/19/12
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 I _ 970-867-8246
Goetz lnsurors, Inc. 970-867-4408
227;Main St - '" - -"
Fort , Mor anCO 80701
Morgan,
Tracy A. Parachini
CONTACT _ ^
PaHOFAX -
c NoNE Ext: A/C No:' '.
E-MAIL
ADDRESS:
PRODUCER FISH-KE
CUSTOMER ID p:
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
INSURERB:American Reliable Insurance Co
19615
INSURER C :
INSURER D
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISIONNUMBER:
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
LTR
TYPE OF INSURANCEADDLISUBF
POLICY NUMBER
POLICY EFF
MM/DDNYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE I OCCUR
X
FSL4160697
"'
11/20/11
11/20/12
EACH OCCURRENCE
$ 1,000,00
PREMISES Ea occurrence
$ 50,00
MED EXP (Any one person)
$ 5,00
PERSONAL B ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER.
X POLICY F7 PRO- LOC
PRODUCTS - COMP/OP AGG
$ $000,00
-
$ -- -- "
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT'
(Ea accident)
$ ,
-
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
WORKERS COMPENSATION
LIABILITY YIN N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
Use, describe under
DESCRIPTION OF OPERATIONS below
N/A
WC STATU- OH
V LI IT
MIEMPLOYERS'
E.L. EACH ACCIDENT
$
E L DISEASE -EA EMPLOYEE
$
E.L. DISEASE -POLICY LIMiT
$
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional 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
The City of Fort Collins
Purchasing Department
PO Box 580
Fort Collins, CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIV
Tracy A. Parachini _st
01988-2009 ACORD CIORpORATION. All rights reserved.
AULIKU 20 (ZUUs/Ua) The ACOKD name and logo are registered marks of ACORD