HomeMy WebLinkAbout20020162.tiff ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID MA DATE(MMIDO YY)
PRODUCER WEN-1 01/07/02
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown, Inc of Lon ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
825 Delaware, Suite f-Longmont HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Longmont CO 80501 ui
Phone: 303-776-3421 INSURERS AFFORDING COVERAGE
INSURED - - - -
INSURER A: MOUNTAIN STATES MUTUAL
Bowen Enterprises DBA INSURER e. Pinnacol Assurance - -
Centennial Backhoe INSURER c: - - -- --
P.O. Box 184
Longmont CO 80501 RERO: - - -- - - - - - -
iINSUSURER E: - - -
COVERAGES
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 TYPE OF INSURANCE POLICY NUMBER POLICY EH I E I I N' - - -
LIABILITY DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS
A GENERAL CPP006954901 01/09/02 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEI $ 1,000,000
11/01/02 tFIREDAMAGE(Anyonanre) J$ 100,000
j CLAIMS MADE Lici OCCUR
'ILMED EXP IAny one person; $ 10,000
I-
i IrPERSONAL&ADV INJURY �1$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000
iii POLICYPRO- FLOC PRODUCTS-COMP/OP AGG $2,000,000
AUTOMOBILE LIABILITY
A X] ANY AUTO BAP0069550 01/09/02 11/01/02 COMBINED SINGLE LIMIT
(Ea accident) $ 1,000,000
,
ALL OWNED AUTOS
SCHEDULED AUTOS BODILY INJURY
(Per person) $
HIRED AUTOS
BODILY INJURY
NON-OWNED AUTOS
(Per accident) I $
PROPERTY DAMAGE l
GARAGE LIABILITY (Per eccitlenl) $
I-1 ANY AUTO AUTO ONLY-EA ACCIDENT $
OTHER THAN EA ACC $—
AUTO ONLY. AGG $
EXCESS LIABILITY
EACH OCCURRENCE $
OCCUR
I I CLAIMS MADE
AGGREGATE $
DEDUCTIBLE - .— $
RETENTION $ _ $
{
WORKERS COMPENSATION AND I l
EMPLOYERS'LIABILITY 1085770 I TORY AlLMTSI IOER
B 04/nl/ni
04/01 /09 I F vnr.H arrinFNr a 1 Mnf1
E .DISEASE-EA EMPLOYEE $ 100000
OTHER E .DISEASE-POLICY LIMIT $500000
A . Inland Marine CPP0069549 01/09/02 11/01/02 Owned Eq. $443,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Rental Eq $ 50,000
CERTIFICATE HOLDER I N ADDITIONAL INSURED:INSURER LETTER:— CANCELLATION
WELDCOU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
WELD COUNTY DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _Z.Q_DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
DEPT. OF PUBLIC HEALTH & ENV.
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
1555 N. 17TH AVE.
GREELEY co 80631 REPRESENTATIVES.
AUTHORIZED REPRESE VE ��j +�
ealier
Karen Roe lidA -'V ACORD 25-S(7197 &cat,'
('p iJ31u i/ C e/idQ 8
J 2002-0162
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