HomeMy WebLinkAbout344657 RMS ELECTRIC - 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 (Agt./Dist.)
RMS Electric Dan C Mausbach
4923 W 9th Street Dr 922 36th Ave
Greeley, CO 80634 Greeley, CO 80634
(970) 352-7778 (120/309)
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.
POLICY DATE
TYPE OF INSURANCE
POLICY NUMBER
LIMITS OF LIABILITY
EFFECTIVE EXPIRATION
(Mo, Day, Yr) (Mo, Day, Yr)
Homeowners/
Bodily Injury and Property Damage
Mobilehomeowners Liability
Each Occurrence $ '000
Bodily Injury and Property Damage
Boatowners Liability
Each Occurrence $ '000
Bodily Injury and Property Damage
Personal Umbrella Liability
Each Occurrence $ '000
Farm Liability & Personal Liability
Each Occurrence $ '000
Farm/Ranch Liability
Farm Employer's Liability
Each Occurrence $ '000
Statutory .........
Workers Compensation and
Each Accident $ ,000
Disease - Each Employee $ '000
Employers Liability t
Disease - Policy Limit $ '000
General Liability
General Aggregate $ 2,000,000
Products -Completed Operations Aggregate $ 2,000,000
❑X Commercial General
Personal and Advertising Injury $ 1,000,000
Liability (occurrence)
05-XW9972-01
07/12/2017
07/12/2018
Each Occurrence $ 1,000,000
❑
❑
Damage to Premises Rented to You $ 100,000
Medical Expense (Any One Person) $ 5,000
Each Occurrencett $ '000
Businessowners Liability
Aggregatett $ '000
Common Cause Limit $ '000
Liquor Liability
Aggregate Limit $ ,QQQ
Automobile Liability
Bodily Injury - Each Person $ 000
❑ Any Auto
❑ All Owned Autos
Bodily Injury -Each Accident $ QQQ
❑ Scheduled Autos
Property Damage $ '000
❑ Hired Auto
Bodily Injury and Property Damage Combined $ '000
❑ Nonowned Autos
Excess Liability
❑ Commercial Blanket Excess
Each Occurrence/Aggregate $ '000
11
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
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 Ft. Collins
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
281 North Collene Ave
Holder named, but failure to mail such notice shall impose no obligation or liability of any kind
*10
y
upon the company, its agents or representatives. days unless different number of days
Po Box 580
shown.
LxJ This certifies coverage on the date of issue only. The above described policies are
Fort Collins, Co 80522.0580
subject to cancellation in conformity with their terms and by the laws of the sta of issue.
DATEISSUED
AUTHO D EPRESENT I
08/04/2017
r
U-201 Ed. 5/00 Stock No. 0666Iev. 7/02