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ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 08;28/0Z°"Y'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Van Gilder Insurance Corp.-STR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
214 South 3rd Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sterling, CO 80751
970 522-6260 I INSURERS AFFORDING COVERAGE
•
INSURED INSURER A: St. Paul Insurance Companies
K& K Roustabout Service - - -INSURER B:
P.O. Box 529
INSURER C:
Sterling„ CO 80751 INSURER D:
I f INSURER 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 I ' 'POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MWDD/YY) LIMITS
A GENERAL LIABILITY VKO8300600 108/28/02 108/28/03 EACH OCCURRENCE !$1 000,000
IX COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) I$100,000
CLAIMS MADE L�OCCUR MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $1,000,000
I GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $2,000,000
POLICY - PRO- f_._.I LOC JECT A AUTOMOBILE LIABILITY VKO8300600 08/28/02 08/28/03 COMBINED SINGLE LIMIT $1,000,000
XI ANY AUTO Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident) $
-_ ___ — ____. PROPERTY DAMAGE
(Per accident) $
II GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ANY AUTO OTHER THAN
EA ACC $
AUTO ONLY: AGG $
EXCESS LIABIUTY • EACH OCCURRENCE $
I OCCUR 1 i CLAIMS MADE ! AGGREGATE $
1 DEDUCTIBLE I $
RETENTION $ $
WORKERS COMPENSATION AND [O ER
EMPLOYERS'LIABILITY •
I E.L.EACH ACCIDENT --- -
$
E.L.DISEASE-EA EMPLOYEE $
E.L.DISEASE-POLICY LIMIT $
OTHER
I
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER 1 ,ADDITIONALINSURED:INSURER LETTER: CANCELLATION
SHOULD ANYOFTH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Weld County DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL la, DAYS WRITTEN
P.O. Box 758 NOTICETOTHE CERTIFICATE HOLD ER NAMED TOTHF '' ^""•""CTM^^D^c"""
Greeley, CO 80632 IMPOSE NO OBLIGATION OR LIABILITY ANYKINC
,,,/Lr c -nA REPRESENTATIVES. 2002-2412
Y_ AUTHORIZED REPRE$EN 4 047-/���r-C
ACORD 25-S(7/97)1 of 1 #M258267 / u DLH 0 ACORD CORPORATION 1988
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