HomeMy WebLinkAboutROY'S ELECTRIC INC - INSURANCE CERTIFICATE (4)CERTIFICATE 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.)
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 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
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 $ 1000
Statutory ............
Workers Compensation and
Each Accident $ '000
Employers Liability t
Disease - Each Employee $ '000
Disease -Policy Limit $ '000
General Liability
General Aggregate $ ,QQQ
Products - Completed Operations Aggregate $ '000
❑ Commercial General
Personal and Advertising Injury $ '000
Liability (occurrence)
❑
Each Occurrence $ ,QQQ
❑
Damage to Premises Rented to You $ '000
Medical Expense (Any One Person) $ ,QQQ
Businessowners Liability
Each Occurrencett $ '000
Aggregatett $ '000
Liquor Liability
Common Cause Limit $ QQQ
Aggregate Limit $ QQQ
Automobile Liability
Bodily Injury - Each Person $ 2,000,000
❑ Any Auto
❑ All Owned Autos
Bodily Injury - Each Accident $ 2,000,000
Property Damage $ 2,000,000
E Scheduled Autos
05-XH2153-03
03/05/2018
03/05/2019
❑ Hired Auto
Bodily Injury and Property Damage Combined $ '000
❑ Nonowned Autos
Excess Liability
❑ Commercial Blanket Excess
Each Occurrence/Aggregate $ ,000
El
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
300 LaPorte Ave I�ECEIVEL
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.
x This certifies coverage on the date of issue only. The above described policies -are
GO J ZU1t�
AUG
subject to cancellation in conformity with their terms and by the law a state of issuei
DATE ISSUED
AUTHORIZED REPR ENTA11E
07/27/2018
YESENIA SAL MoN, t
Gity Manager's !Cffii2;
U-201 Ed. 5/00
%` —
Stock No. 06668 Rev. 7/02