HomeMy WebLinkAbout20030098.tiff Client#: 11603 GREWEI
ACORDTM CERTIFICATE OF LIABILITY INSURANCE ,ATzi/oz0""")
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
R
9351 Grant Street, Suite 600 - ALTER T.THIS CERTIFICATE DOES NOT AMEND,EXT E
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Thornton, CO 80229
720 977-7110 o.
t -'• .I. _ `; INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: ACE USA
Greeley-Weld County
Airport Authority (y`( _ INSURER B: Travelers Insurance
INSURER c: Pinnacol Assurance
P 0 Box 727 INSURER D:
Greeley, CO 80632
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 ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTP. NSR[ TYPE OF INSURANCE POLICY NUMBER DATE(MWOD/YY) DATE IMM/DD/YYI LIMITS
A GENERAL LIABILITY AAPN00054240 01/01/03 01/01/04 EACH OCCURRENCE $5,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
( aPREMISES R()Moreno.) $50,000
CLAIMS MADE X OCCUR MED EXP(Any one person) $1,000
PERSONAL B ADV INJURY $5,000,000
GENERAL AGGREGATE $5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $5,000,000
X POLICY n PRO-T �I
JEC I LOC
B AUTOMOBILE LIABILITY 18103340W827INDO3 01/01/03 01/01/04 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS
(Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
IOCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
C WORKERS COMPENSATION AND 1556902 01/01/03 01/01/04 X ORY LIMU- I IOEH-
EMPLOYERS'LIABILITY ORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $100,000
OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000
If yes,describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000
B OTHER Commercial 1660820X6506COF03 01/01/03 01/01/04 Ded $250
Buildings Special Form Blanket Limit$3,664,360
Personal Property Replacement Cost Blanket Limit$53,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Miscellaneous Coverage -General Liability-Pol.#AAPN00054240
Form Information
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
WELD COUNTY COMMISSIONERS DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL in DAYS WRITTEN
915 10TH NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
Greeley, CO 80631 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Rood 4:20164 Z n. Insca n A 1 Inc.
ACORD 25(2001/08) 1- of 3 - #S235355/M235348 VFR 0 A
(Iv? 2003-0098
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.
ACORD 25-S(2001/08) 2 of 3 #S235355/M235348
DESCRIPTIONS (Continued from Page 1)
Form Description: Malpractice Annual Aggregate Limit Limit#1: 5,000,000
Form Description: HangarKeepers Liability- Limit 1= Each aircraft, Limit
2= Each occurence Limit#1: 5,000,000 Limit#2: 5,000,000
Ded.#2: $1,000
AMS 25.3(2001/08) 3 of 3 #S235355/M235348
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