HomeMy WebLinkAbout20031574 Client#: 12170 GRECI
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATEosi0aro3D )
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: Nationwide Life Ins. Co.
City Of Greeley INSURER B:
dba Rocky Mountain Senior Games INSURER C:
1010 6th Street
INSURER D:
Greeley, CO 80631
INSURER E:
COVi. .GES
1,- wl ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
A"' DUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
t•. ?TAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH
F,... ' 3.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
JNSr ' POLICY EFFECTIVE POLICY EXPIRATION
I LT ix I TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDM9 DATE IMM/DD/YY) LIMITS
A GENERAL LIABILITY SSP0001018800 05/07/03 01/29/04 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO PREMISES RENTEDa occurrence) $300,000
CLAIMS MADE 7OCCUR MED EXP(Any one person) $5,000
' PERSONAL Si ADV INJURY $1,000,000
GENERAL AGGREGATE $
IL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000
POLICY PPM n LOC '" 31,000,000
siOBILE LIABILITY
COMBINED SINGLE LIMIT $
'JO/AUTO
(Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
J
k HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE $
(Per accident)
,E LIABILITY AUTO ONLY-EA ACCIDENT 5
"V AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
:UMBRELLA LIABILITY EACH OCCURRENCE $
, OCCUR n CLAIMS MADE AGGREGATE 5
$
DEDUCTIBLE $
_ RETENTION $ $
S COMPENSATION AND I TORYS LIMITS I IG R
.S'LIABILITY
- "'OR/PARTNER/EXECUTIVE E.I.EACH ACCIDENT 5
ER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $
under
_ SIONS below E.L.DISEASE-POLICY LIMIT $
L E:. F OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS
.,*
r'ai. ant Legal Liability
The cr . ate holder is an additional insured per Form CG 2011 -Lessors
or f, •s or Premises but only with respects to the operations of the
ins
LDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
41d County Colorado By& DATE THEREOF,THE ISSUING INSU L ENDEAV TO MAIL _ DAYS WRITTEN
• -ough the Board of County NOTI THE CERTIFICATE HO ER NAM TOTH LE ,BUT FAILURE TODOSOSHALL
/ -m m i ss i o n ers of Weld County, IMPOSE NO 'CATION OR UA UTY OF AN KIND THE INS ER, AGENTS OR
I 7H?Weld County Sheriff&their REPRESENTATI S.
e -Dloyees - 915 10th Street A ORIZED R R V
cta'I` t / elev. CO 80631
//d�o _08) 1 of 2 #S249288/M249281 M 2003-1574
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