HomeMy WebLinkAboutROY'S ELECTRIC INC - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company if selection box is not checked.
6000 American Pky Madison, Wisconsin 53783-0001
Insured's Name and Address Agent's Name, Address and Phone Number (AgtJDist.)
Roy's Electric Inc Yesenia Salomon
1610 Pace St Unit 900-439 917 S Main St Ste 200
Longmont, CO 80501 Longmont, CO 80501
(303) 485-0745 (034/309)
This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder.
This certificate does not amend, extend or alter the coveraoe afforded by the Dolicies listed below.
COVERAGES
This is to certify that 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.
TYPE OF INSURANCE
POLICY NUMBERPOLICY
DATE
LIMITS OF LIABILITY
EFFECTIVE Day, (Mo. EXPIRATION
(Mo, Day, Yr) (Mo. Day, Vr)
Homeowners/
Bodily Injury and Property Damage
Mobilehomeowners Liability
Each Occurrence $ '000
Boatowners Liability
Bodily Injury and Property Damage
Each Occurrence $ '000
Personal Umbrella Liability
Bodily Injury and Property Damage
Each Occurrence $ '000
Farm Liability & Personal Liability
Farm/Ranch Liability
Each Occurrence $ '000
Farm Employees Liability
Each Occurrence $ '000
Statutory ......
Workers Compensation and
Each Accident $ '000
Employers Liability t
Disease - Each Employee $ 000
Disease - Policy Limit $ ,000
General Liability
General Aggregate $ '000
Products - Completed Operations Aggregate $ '000
❑ Commercial General
Personal and Advertising Injury $ 000
Liability (occurrence)
❑
Each Occurrence $ '000
❑
Damage to Premises Rented to You $ '000
Medical Expense (Any One Person) $ ,000
Businessowners Liability
Each Oocurrencett $ '000
Aggregatett $ '000
Liquor Liability
Common Cause Limit $ '000
Aggregate Limit $ 000
Automobile Liability
Bodily Injury - Each Person $ 2,000,000
❑ Any Auto
❑All Owned Autos
Bodilylnjury - Each Accident $ 2,000,000
Property Damage $ 2,000,000
Scheduled Autos
05-XH2153-03
03/05/2015
03/05/2016
❑ Hired Auto
Bodily Injury and Property Damage Combined $ '000
❑ Nonowned Autos
El
Excess Liability
❑ Commercial Blanket Excess
Each Occurrence/Aggregate $ '000
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS tThe individual or partners ❑ Have
shown as insured elected to
be covered under this policy. ❑ Have not
"Products -Completed Operations aggregate
Is equal to each occurrence limit and is
included in policy aggregate.
CERTIFICATE HOLDER'S NAME AND ADDRESS
CANCELLATION
Cityof Ft Collins
Y
❑ Should any of the above described policies be cancelled before the expiration date
thereof, the company will endeavor to mail '( days) written notice to the Certificate
300 LaPorte Ave
Holder named, but failure to mail such notice shall impose no obligation or liability of any kind
upon the company, its agents or representatives. *10 days unless different number of days
Ft Collins, CO 80524
shown.
LxJ This certifies coverage on the date of issue only. The apove described policies are
subject to cancellation in conformity with eir terms and by the I ws of tit ate of issue.
DATEISSUED
T ORIZED PRE T TIV
03/10/2015
U-201 Ed. 5/00 Stock No. 06668 Rev. 7/02