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HomeMy WebLinkAbout490634 DOUGLAS B HOLT & TUBA USTUNER - INSURANCE CERTIFICATEHOLTD-1 OP ID: CS ,a►�oRo CERTIFICATE OF LIABILITY INSURANCE DAT12114112 ) 2/14112 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 970-945-9161 GIA Group/Glenwood Ins. Agency 970-945-6027 P O BOX 1270INC. Glenwood Springs, CO 81602-1270 Robert Asa Jones CONTACT PHONE FA% No Eat : AIC No): ADDRESS: INSURERS AFFORDING COVERAGE NAIC a INSURER A:TraVelers INSURED Douglas B. H It fY Tuba 904 Garfield St. Fort Collins, CO 80524 INSURER B: _ INSURER C 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 LTR TYPE OFINSURANCE POLICY NUMBER MM/DD(YYYY MMLDD/W pY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 6805BO37901 03/10/12 03/10/13 PREMISES Ea occurrence $ 300,00 CLAIMS -MADE I -XI OCCUR MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ ,,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2,000,00 $ POLICY PRO- LOC MOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ NY AUTO BODILY INJURY (Per accident) $ LL OWNED SCHEDULED FALITOS IRED AAUTOS NON -OWNED UTOS AUTOS PROPERTY DAMAGE Peraccidenl $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ A EXCESS LIAB CLAIMSWADE CUP113906068 03/10/12 03/10/13 DED I X I RETENTION$ 5,000 S WORKERS COMPENSATION ANDEMPLOYERTLIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMIEMBER EXCLUDED' NIA VvC STATU- OTH- Y IM E.L. EACH ACCIDENT $ (Mandatary In NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT 1 $ II describe under DESCRIPTION OF OPERATIONS below A Property Section — - 68OBB037901 03/10/12 03/10/13 Building - - 1,200,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more apace Is required) Certificate holder is named as additional insured. RE:221-227 Jefferson, Fort Collins, CO CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fort Collins Utilities THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 117 N Mason St. Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD