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HomeMy WebLinkAbout490634 DOUGLAS B HOLT & TUBA USTUNER - INSURANCE CERTIFICATE (2)HOLTD-1 OP ID: CS '4��R" CERTIFICATE OF LIABILITY INSURANCE DAT03/20DIYYYYI 03/20/13 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 endorsement(s). PRODUCER 970-945-9161 GIA Group/Glenwood Ins. Agency 970-945-6027 P D Box 1270 Glenwood Springs, CO 81602-1270 Robert Asa Jones CONTACT NAME: FAx IAIC Ni A/C No : E-MAADDRESS: INSURERS AFFORDING COVERAGE NAIC IN INSURER A:TraVelers IV h/ INSURED Douglas B. Holt & Tuba Ustune 223 Jefferson St. Fort Collins, CO 80524 INSURER B: 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 INSURANCEADDLISUBIR POLICY NUMBER POLICY EFF MMIDDNYYY POLICY E%P MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR 6605B037901 03110113 03110114 PREMISES Ea occunence S 300,00 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. PRODUCTS - COMPIOP AGG $ 2,000,00 POLICY Pft0 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ _ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE Peraccident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,00 gGGREGATE $ A EXCESS LIAB CLAIMS -MADE CUPIB906068 03110113 03/10/14 DED X RETENTIONS S OOO $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORMARTNER/EXECUTIVE T RY IM T E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ NIA EL DISEASE -EA EMPLOYEE S (Mandatory In NH) It yes, dasoioe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Property Section X 6805BO37901 03/10/13 03110114 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace is required) Certificate holder is named as additional insured. RE: 221-227 Jefferson St. Fort Collins, CO City of Fort Collins P.O. Box 280 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD