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POST OFFICE BOX$7 1000 LIONSRIDGE LOOP VAIL COLORADO 81658 'A03 476 6342 FAX X03 06 qg0 i {
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FROM : NANCY RAY-AMERICAN FAMILY INS. PHONE NO. : 303 949 5633 P01
` CERTIFICATE OF INSURANCE
American Family Mutual Insurance Company
3099 East Washington Avenue
Madison. Wisconsin 517A4-0001
Agant's Name and Address
Nancy Ray This certificate is issued as a matter of information
PO BOX 2758 only and curifers no rights upon the Certiticate Holder,
Avon, CO 81620
This certificate does not amend. extend or alter the
Insureds Name and Addrosa covorago afforded by the policies listed below.
Chuck Botcher
dba Botcher Construction
PO BOX 4444
Vail, CO 81658
CONES
This is to certify that policies of insurance listed below have bean issued to the insured named above fnr the policy
period indicated, notwithsLanding,any requirement, term or condition of any contract or other document with respect
,
to which this certificate may be ssuod or may pertain, the insurance arfurded by the policies described herein is
subject to all the terns, exclusions, and conditions of such policies
TYPE or POLICY POLICY DATE LIMITS OF
INSURAN'F Ni,M6ER EFFECTWC EXPIRATION LIABILITY
(MOJAY_rR) (I+D_DAY_1
R) Statutory eerrr*�,c�xKwr■.
POWERS COMPENSATION Each Accident ,000
AND Disease-Each Employee ,000
EMPLOYERS LIABILITY+ Disease Policy Limit ,000
UNERAL LIABILITY
0aneral Aggregat4 $2,000 1000
EXI Commercial General 05X50628 4-20-93 4-20-94 Products-Completod Operstions
Liability Aggregate 2.D00 ,000
(oaourrence) Personal and Advertising Injury 1,400 1000
1 ] Each Occurrence 1,000 1000
Ciro Damage (Any One Fire) 50 0000
E ' Medical Exponco (Any Ono Pot-can) 5 ,000
ERS LIABILITY
E ] Commercial General Each Occurrence ++ ,Ono
Liability Aggregate ++ ,000
A1lrOMOBILE LIABILITY
C ] Owned Auto$ Bodily Injury - Each Person S ,000
(Basic FOrsi)
[ ] Owned Autos Budily Injury - Each Accident $ 1000
(Comprehensive Form)
C ] Hired Autos
E ] Non-owned Autos Property Damage S ,000
[ ] Garap4 Iiability
I Bodily Injury and
r V Oamane Combined S 000
EXCESS LlrtiILITY Prana
C ] Commercial Umbrella
Each Occurrence/Aggregate t 1000
brSCRIPTIOR PERA1'IONf,/LQCA z N5/VFtilC E /RESTRI 5rt4.iAL /
carpentry
+The individual or partners shown as Insureds E 7Have E ]Nava not
elected to b covered as employees under this policy.
++products-Completed Oporations aggregate is eyuol to each occurrence
QRFICA w— HJ1ME t —1fi CAK inTION ir �r r S!o
Town of Vail Should any of the above described policies be canceled
• 75 S. Frontage Rd, before the expiration d.LLe thereof, the undersigned
Faxl , Co 81657 company will endeavor to mail e( days) written notice
to the Certificate Holder named to the left, but failure to
mail such notice shall impose no obligation or liability of
any kind upon the l,wpany, its agents or representatives.
d10 days uAIxt9 diffaror%k number of
vt shown.
WE ISSUED 0 08-93 0 REPRE$ RIVE UBL-11781 Ed. 11/90 �/�,�iC.It/'" '
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