HomeMy WebLinkAbout20031362.tiff Client#: 28923 LANBU
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE IM sWYYTY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood &Peterson Ins. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. O. Box 578 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W. 18th Street
Greeley, CO 80632 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Auto-Owners Insurance Group
Landmark Builders of Greeley, Inc. INSURER B: Pinnacol Assurance
3812 Carson Street INSURER c: Fireman's Fund Insurance, Co.
Evans, CO 80620
INSURER D:
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% POLICY EFFECTIVE POLICY EXPIRATION
LTR NSRE TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE IMM/DD/YY) LIMITS
A GENERAL LIABILITY BINDER219569 06/01/03 06/01/04 EACHOCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES(Ea occurrence) $100,000
CLAIMS MADE n OCCUR MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
nPOLICY n m n LOC
A AUTOMOBILE LIABILITY BINDER219569 06/01/03 06/01/04 COMBINED SINGLE LIMIT $1,UOD,0
ii ANY AUTO (Ea accident)
00
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 $
nOCCUR CLAIMS MADE AGGREGATE $
$
HDEDUCTIBLE $
RETENTION S S
B WORKERS COMPENSATION AND 4043929 06/01/03 06/01/04 WC LJMIT OTH-
EMPLOYERS'LIABILITY I TORY LIMITS I I FR
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000
OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE s500,000
If yes,describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT s500,000
C OTHER Inland BINDER222538 06/01/03 06/01/04
Marine
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Weld County Public Works Service Center, Weld County Business Park,
Greeley, Colorado
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
County of Weld, Colorado DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
915 10th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
Greeley, CO 80631 IMPOSE NO OBLIGATION OR LIABILITY OF AN KIND PON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
4J//)e1.4//er,4277cel.) Ay'rHORIZED R RESEN TIVE
O6-, --e-.7-2, l 1 Il ,ILi
ACORD 25(2001/08) I of 2 #S248334/M248324 KFP I
2003-1362
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