HomeMy WebLinkAbout357006 LYNNETTE KEIM DBA ALL AMERICAN BACKFLOW - INSURANCE CERTIFICATEACORI
llll� CERTIFICATE OF LIABILITY INSURANCE
05-13/-2013
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 INSURERISI. AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder is an ADDITIONALINSURED, the policylies) must be endorsed. If SUBROGATIONIS 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($).
PRODUCER
LEID FINANCIAL GROUP INC/PHS
342560 P:(866)467-8730 F:(877)905-0457
CONrACT
NAME:
PHONE
p E.n: (866)467-8730 wlc, Nol: (877)905-045
ADDRESS:
PO BOX 33015
INSURERS) AFFORDING COVERAGE NAICk
SAN ANTONIO TX 78265
INSURER A: Hartford Casualty Ins Co
INSURED _ 7�� B O
INSURER B
LYNNETTE KEIM DBA ALL AMERICAN BACKFLOW
215 E 2ND ST
INSURER C:
INSURER D
INSURER E:
LOVELAND CO 80537
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.
ILEE
Tfl
TYPE OF INSURANCE
INSq
WVD
POLICY NUMBER
I FF IMMIDDIVVVV)
(MMIDDIVVYV)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1, 000, 000
A
COMMERCIAL GENER�AyL L�IABILITY
I CLAIMS MADE i X 1 OCCUR
X General Llab
U
_
u
34 SEA PE5367
05/26/2013
05/26/2014
PREMI10,<urrencel
$ 300, O00
MILD EXP (Any one person)
$ 10 , 0 0 0
PERSONAL&ADVINJURY
I $ 1 00O 000
GENERAL AGGREGATE
I $ 2,000, 000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY J PRPECT Lx LOC
J
PRODUCTS-COMP/OP AGG
$2, 000, 000
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
IEa accidenq
,$
ANYAUTO
BODILY INJURY (Per person)
I $
ALL OWNED I I SCHEDULED
AUTOS I� AUTOS
HIRED AUTOS I NONOWNEDPROPERTY
u AUTOS
I
u
u
BODILY INJURY (Per accident)
$
DAMAGE
We, accidenq
$
$
UMBRELLA LIAR u
OCCUR
EXCESS LIAB CLAIMS -MADE
_I
u
_
u
RRENCE
$
I
Z
$
DED I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE—
OFFICER/MEMBER EXCLUDED) a
(Mendetory in NH)
If yea, describe ender
DESCRIPTION OF OPERATIONS below
N/A
a
_
TU- OTH
TORY OMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT I
$
uu
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ADAch ACORO 101. Adtlilionel RemerNs Scbedula, it more space M required)
Those usual to the Insured's Operations.
rcorinrnrc unr nrn _
The City of Fort Collins
Purchasing Dept
PO BOX 580
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.
AUTHORIZ�EQv/UPPRESENTATIVE
ACORD Z5 (2010/05)
0 ACORD
The ACORD name and logo are registered marks of ACORD
All einufo eeo--A