HomeMy WebLinkAbout515849 KEN, LINDA & BRIAN FISHER - INSURANCE CERTIFICATEOP ID: DS
CERTIFICATE OF LIABILITY INSURANCE
MTEIMMIDD/
�'02112/2013 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 endorsements .
PRODUCER Phone: 970-8671246
Goetz lnsuror3, Inc.
227 Main St Fax: 970-867-4408
Fort Morgan, CO 80701
Tracy A. Parachini
�ICC(� t
y�
NAMEAO
PHONE FAX
AIC No Elf AIC No
EJMIL
ADDRESS:
Pao cE OMER ID Y:FISH-KE
CUS
INSURE 5 AFFORDING COVERgGE
INSURERA:American Bankers Insurance Co
NAIC0
10111
INSURED Ken, Linda & Brian Fisher
Kenlyn Stables, Inc
INSURER B:
4916 Bingham Hill Rd
INSURER C:
Fort Collins, CO 80521-1073
INSURER D :
INSURER E :
INSURER F :
"- "-"'�-'•' RCVIJIVN NUMHGK:
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.
E OF INSURANCE
POLICY NUMBER
MMILDDDlYYVY
M LMIDDYEYYY
LIMITS
TY
ALGENERALLIABILITY
S-MADE � OCCUR
M
X
FSL4160697
11/20/2012
1112012013
EACH OCCURRENCE
$ 1,000,00
pREMISEs Eaamr713
rrence
MED EXP (Airy we Person)
$ 50,00
$ 5,00
PERSONAL A ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
TE LIMIT APPLIES PER:
PRO- LCC
PRODUCTS-COMP/OPAGG
$ 2,000,00
$
AUTOMOBILE
LIAMUTY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
COMBINED SINGLE LIMIT
(Ea accitlenf)
$
BODILY INJURY (Par person)
$
BODILY INJURY (Per ecddenU
q
PROPERTY DAMAGE
(Per ecdtlenf)
$
f
f
UMBRELLA LAB
EXCESS LAB
OCCUR
C1_AIMSA1AOE
N/A
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION
WORKERS COMPENSATION
AND EMPLOYERS VERS'LILIABIUTY YIN ANY PROPR ETC)RrPARTNERIEXECUTIVE
OFFICERNEMBER EXCLUDED? ❑
If ..Ai I,e NH)
Ifyes,desvlhe H)
DE SCRIPTIONOFOPERATIONSb J.
$
WC STATU- OTH.
E
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aflach ACORD 101, AWAIMal Remarks Schedule, It mole apace is requlfed) - - -
Certificate holder is additional insured in respect to hay operation. T
Additional insured includes The City, its officers, agents and employees. Kenneth P.F18hei
4916 Bingham Hill Rd.
' Fort Collins, CO 80521-1073
rGRT¢Ir ATc unI non
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.
AUTHORUMD REPRESENTATIVE
Tracy A. Parachini
ACORD CORPORATION. All rights
•- I---- -.f 1lie ml-umu name and logo are registered marks of ACORD