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Home My WebLink About20092656.tiffACORDTM CERTIFICATE OF LIABILITY INSURANCE 12/31 /2009 DATE (MM/DD/YYYY) 9/30/2009 PRODUCER Lockton Companies, LLC-1 Kansas City 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 (816) 960-9000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOI ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATI HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND O ALTER THE COVERAGE AFFORDED BY THE POLICIES BELON INSURERS AFFORDING COVERAGE INSURER A : I Milford Casualty Insurance Company INSURER B Firemans Fund INSURER c . Granite State Insurance Company NAIC # INSURED US CABLE OF COASTAL -TEXAS, L.P. 1309892 DBA US CABLE OF WEST TEXAS 28 WEST GRAND AVENUE Suite 10 MONTVALE NJ 07645 29424 78722 23809 INSURER 0 INSURER E COVERAGES USCAB01 ZH THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSU INSURERIS). AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLD THE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 37UUNAK0159 9/30/2009 12/31/2009 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES(Ea occurence) $ 300,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY I I JECT OFX ILOC PRODUCTS - COMP/OP AGG $ 2,000,000 7 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 37UENAK0228 9/30/2009 12/31/2009 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ XXXXXXX X BODILY INJURY (Per accident) $ XXXXXXX X PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE LIABILITY ANY AUTO NOT APPLICABLE AUTO ONLY EA ACCIDENT $ XXXXXXX OTHER THAN EA ACC $ XXXXXXX AUTO ONLY: AGG $ XXXXXXX B EXCESS/UMBRELLA X I LIABILITY 5OO71007678 9/30/2009 12/31/2009 EACH OCCURRENCE $ 5,000,000 OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 $ XXXXXXX UMBRELLA X FORM $ XXXXXXX DEDUCTIBLE RETENTION $ $ XXXXXXX C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? u yes, dezcdbe under SPECIAL PROVISIONS below 1`10 WC651-7453 9/30/2009 9/30/2010 XI WC STATU- I IOTH- TORY LIMITS 10ER E. L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E . DISEASE POLICY LIMIT $ 1,000,000 A OTHER REAL & PERSONAL PROPERTY 37UUNAK0159 9/30/2009 12/31/2009 ALL RISK FORM. $10,000 DEDUCTIBLE. DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED UNDER THE GENERAL LIABILITY POLICY, WHERE REQUIRED BY WRITTEN CONTRACT ,dill 4“,,e7/ r&.*c �� y / D -7-n CERTIFICATE HOLDER 3904869 WELD COUNTY ATTN: BILL HAWKINS P.0 BOX 758 GREELY CO 80632 2009-2656 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHAL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS 0 REPRESENTATIVES. AUTHORIZED REPRESEN7RU/E the dam seat or. © ACORD CORPORATION 198 ACORD 25 (2001/08) For questions regarding this certificate, contact the number listed In the Produce/ section above and sped Hello