HomeMy WebLinkAboutLAKE CONTRACTING - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company, S.I. 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 (Agt./Dist.)
Lake Contracting Wilfrido A David
2590 Brittany Dr 2956 GINNALA DR STE 102
Loveland, CO 80537 LOVELAND, CO 80538
(970) 612-0865 (003/309)
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 coverage afforded by the policies 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 NUMBER
POLICY DATE
LIMITS OF LIABILITY
EFFECTIVE EXPIRATION
(Mo, Day, Yr) (Mo, Day, Yr)
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 Employer's Liability
Each Occurrence $ '000
Statutory ... » ... .
Workers Compensation and
Each Accident $ '000
Disease - Each Employee $ '000
Employers Liability t
Disease - Policy Limit $ 1000
General Liability
0 Commercial General
Liability (occurrence)
❑
05-XBO969-04
10/11/2018
10/11/2019
General Aggregate $ 2,000,000
Products - Completed Operations Aggregate $ 2,000,000
Personal and Advertising Injury $ 1,000,000
Each Occurrence $ 1,000,000
❑
Damage to Premises Rented to You $ 100,000
Medical Expense (Any One Person) $ 5,000
Businessowners Liability
Each Occurrencett $ 1000
Aggregatett $ ,000
Liquor Liability
Common Cause Limit $ 000
Aggregate Limit ' $ ,000
Automobile Liability
Bodily Injury - Each Person $ 1,000,000
❑ Any Auto
❑ All Owned Autos
Bodily Injury - Each Accident $ 1,000,000
E Scheduled Autos
05-XBO969-02
07/14/2018
07/14/2019
Property Damage $ 1,000,000
❑ 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
Additional Insured: City of Fort Collins shown as insured elected to
be covered under this policy ❑ Have not
ttProducts-Completed Operations aggregate
is equal to each occurrence limit and is
included in policy aggregate.
CERTIFICATE HOLDER'S NAME AND ADDRESS
CANCELLATION
City of Fart Collins
x Should any of the above described policies be cancelled before the expiration date
thereof, the company will endeavor to mail `( 30 days) written notice to the Certificate
281 N. College 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
Fort Collins, CO 80524
shown.
EJ This certifies coverage on the date of issue only. The above described policies are
subject to cancellation in conformity with their terms and by the laws of the state of issue.
DATE ISSUED
AUTHORIZED REPRESENTATIVE
10/16/2018
Kelly Mengel
U-201 Ed. 5100 Stock No. 06668 Rev. 7/02