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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 Radcliff Upholstery LLC Radcliff Roland PO Box 264 Louisville, CO 80027 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. Agent's Name, Address and Phone Number (Agt./Dist.) Bob Prantner (303) 666-5552 511 South Boulder Road Louisville, CO 80027 (016/311) 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/ Mobilehomeowners Liability Bodily Injury and Property Damage 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/Ranch Liability Farm Liability & Personal Liability Each Occurrence $ ,000 Farm Employer's Liability Each Occurrence $ ,000 Workers Compensation and Employers Liability t Statutory +.......++.+ Each Accident $ ,000 Disease - Each Employee $ ,000 Disease - Policy Limit $ ,000 General Liability f%J Commercial General Liability (occurrence) ❑ ❑ Pending 11/3/2008 11/3/2009 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 $ 1 00 ,000 Medical Expense (Any One Person) $ 5 ,000 Businessowners Liability Each Occurrencet t $ 000 Aggregatett $ ,000 Liquor Liability Common Cause Limit $ ,000 Aggregate Limit $ ,000 Automobile Liability ❑ Any Auto ❑ All Owned Autos ❑ Scheduled Autos ❑ Hired Auto ❑ Nonowned Autos ❑ BodilyInjury - EachPerson $ ,000 Bodily Injury - Each Accident $ ,000 Property Damage $ ,000 Bodily Injury and Property Damage Combined $ 000 Excess Liability ❑ Commercial Blanket Excess Each Occurrence/Aggregate $ ,000 Other (Miscellaneous Coverages) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS t The individual or partners shown as insured ❑ Have ❑ Have not elected to be covered as employees under this policy. t t Products -Completed Operations aggregate is equal to each occurrence limit and is included in policy aggregate. CERTIFICATE=HOLDER'S''NAME AND,ADDRESS -= CANCELLATION . City of Louisville 749 Main St Louisville Co 80027 ® 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 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 shown. ❑ This certifies coverage on the date of issue only. The above described policies are subject to cancellation in confor -ity with their terms and by the laws of the state of iss, DATE ISSUED AUTHORI5.01ESE , ATIVE .ma's U-201 Ed. 5/00 Certificate Holder Stock No. 06668 Rev. 7/02