HomeMy WebLinkAboutTIMOTHY M KEOHANE - INSURANCE CERTIFICATE (3)9Erie
Insurance
100 Erie Ins. PI. • Erie, PA 16530
CERTIFICATE OF INSURANCE
- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY -
CERTIFICATE HOLDER COPY
NAME AND NUMBER OF AGENCY
KELLY FAMILY INSURANCE AGY INC
NN1037
196 S MAIN ST
NAPLES . NY 14512-9508
585-374-9320
NAME AND ADDRESS OF NAMED INSURED
TIMOTHY M KEOHANE +
PO BOX 662
NAPLES NY 14512-0662
01/19/2015
NAME AND ADDRESS OF CERTIFICATE HOLDER
CITY OF FORT COLLINS
117 N MASON ST
FORT COLLINGS CO 80524—
This is to certify that policies, as indicated by Policy Number below, are In force for the Named Insured at the time that the certificate is being issued.
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
Q267220068
02/22/2015
02/22/2016
EACH OCCURRENCE
$ 300000
FIRE DAMAGE
(Any one premises)
$ 300000
OCCURRENCE FORM -
GEN'L AGGREGATE LIMIT APPLIES
PER: POLICY
MED EXP (Any one person)
$ 5000
PERSONAL S ADV INJURY
S 300000
GENERAL AGGREGATE
$ 600000
PRODUCTS-COMP/OP AGG$
600000
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
EACH OCCURRENCE
AGGREGATE
WORKERS COMPENSATION Q867200103 02/22/2015 02/22/2016 1STATUTORY
AND BODILY ACCIDENT $ 100000 EACH ACCIDENT
EMPLOYERS LIABILITY INJURY DISEASE S 500000 POLICY LIMIT
BY DISEASE S 100000 EACH EMPLOYEE
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CANCELLATION: SHOULD ANY OF THE
POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
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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
THIS CERTIFICATE IS ISSUED FOR INFORMATION PURPOSES ONLY AND
CONFERS NO RIGHTS ON THE CERTIFICATE HOLDER. IT DOES NOT
AFFIRMATIVELY OR NEGATIVELY LIST, AMEND, EXTEND OR OTHERWISE
ALTER THE TERMS, EXCLUSIONS AND CONDITIONS OF INSURANCE
COVERAGE CONTAINED IN THE POLICY(IES) INDICATED ABOVE. THE TERMS
AND CONDITIONS OF THE POLICY(IES) GOVERN THE INSURANCE COVERAGE
AS APPLIED TO ANY GIVEN SITUATION. LIMITS SHOWN MAY HAVE BEEN
REDUCED BY CLAIMS PAID. THIS CERTIFICATE OF INSURANCE DOES NOT
CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
ERIE INSURANCE
SEE REVERSE SIDE
OF-1568 09112 CIF
AUTHORIZED
REPRESENTATIVE /s.�v