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ACORDTM CERTIFICATE OF LIABILITY INSURANCE Page 1 of 3 05/31/2002
PRODUCER 877-559-6769 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis North America, Inc. - Regional Cert Center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
11201 N. Tatum Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 300
Phoenix, Si 85028 .,, INSURERS AFFORDING COVERAGE
INSURED SRS Support Services, Inc. INSURER A: Zurich American Insurance Company 16535-002
14900 Landmark Boulevard INSURER B:American Guarantee and Liability Insuranc 26247-001
Suite 400
Dallas, TX 75254 INSURER C:
INSURER 0:
I INSURERS
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 POLICY EFFECTIVE POLICY EXPIRATION LIMITS
ern TYPE OF INSURANCE POLICYNUMBER DATE IMM/DDNY) DATE IMM/DD/YY)
A GENERAL LIABILITY GL0234708300 6/1/2002 6/1/2003 EACH OCCURRENCE $ 1.000.000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 50,000
CLAIMS MADE X OCCUR MEDEXP(Any one person) $ 5,000 -
PERSONALdADVINJURY $ 1,000.000
GENERAL AGGREGATE $ 5.000.000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000.000
POLICY PEOT LOC
A AUTOMOBILE UABILITY AOS BAP234708500 6/1/2002 6/1/2003 COMBINED SINGLE LIMIT $ 1,000,000
B X ANY AUTO TX TAP234708400 6/1/2002 6/1/2003 (Ea sodden§
ALL OWNED AUTOS BODILY INJURY $
(Per person)
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY $
(Per sodden')
NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE ,$
I OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ V/ UMTI SI IO _ $
A WORKERS COMPENSATION AND AOS WC234708200 6/1/2002 6/1/2003 X ITORVER I
EMPLOYERS'LIABILITY
E.L EACH ACCIDENT $ 1,000.000
E.L.DISEASE-EA EMPLOYEE $ 1.000.000
E.L.DISEASE-POLICY LIMIT $ 1,000.000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
All policies indicated are primary and non-contributory as respects any other
insurance in force.
It is a condition of the General Liability policy that the general aggregate
applies on a per project basis.
CERTIFICATE HOLDER I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION Except 10 days for Eon-payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
l�/A��07 p�p DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
<V <-'/( 14 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
-7 7 _6 d�, IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATV
Board of county Commissioners of Weld County -.
915 Tenth Street AUTHORIZED P ENTATIVE
Greeley, CO 80632
ACORD25-S(7/97) Co11:466698 Tp1:96215 Cert:1847763 ®/
2002-1589
DATE
wIIIIS CERTIFICATE OF LIABILITY INSURANCE Page 2 A Mof 3ATTER OF 05 i F31/200 N
PRODUCER 877-559-6769 THIS CERTIFICATE IS ISSUED ASONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis North America, Inc. - Regional cert center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
11201 N. Tatum Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
suit. 300
Phoenix, AZ 85028 INSURERS AFFORDING COVERAGE
INSURED SXID Support Services, Inc. INSURERA: Zurich American Insurance Company 16535-002
14900 Landmark Boulevard INSURERS:American Guarantee and Liability Insuranc 26247-001
Suits 400
Dallas, TX 75254 INSURERC:
INSURER D:
INSURER E:
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: All operations of the insured during the Performance Period:
01 Jan 2001 through 31 Dec 2002
It is a condition of the General Liability, Automobile Liability and
Workers' Compensation policies that Weld County, Colorado and Weld County
Library Association are hereby added as additional insureds, only to the
extent assumed by the insured under the written contract, subject to the
policy terms, conditions and exclusions.
r
Co11:466698 Tp1:96215 Cert:1847763
Page 3 of 3
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD25-S(7/97) Co11:466698 Tp1:96215 Cert:1847763
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