The URL can be used to link to this page

Browse Search

Home My WebLink About20013385.tiff ACOR TM CERTIFICATE OF LIABILITY INSURANCE 12/03/2001 PRODUCER (303)824-6600 FAX (303)370-0118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Moody Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 3773 Cherry Creek North Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 800 INSURERS AFFORDING COVERAGE Denver, CO 80209-3804 INSURED Quality Paving Company INSURER A: Travelers Property Casualty Quality Resurfacing Company INSURER B'. American Dynasty PO Box 519 INSURERS Pinnacol Assurance Henderson, CO 80640-0519 INSURER D: St Paul Companies I 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. POLICY EFFECTIVE POLICY EXPIRATION LTR MI R I TYPE OF INSURANCE POLICY NUMBER DATE IMDD/YYI DATE IMMIDD/YYI LIMITS GENERAL LIABILITY DTC0754G6115TIA01 12/01/2001 12/01/2002 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 300,000 I CLAIMS MADE X OCCUR MED EXP(Any one person) $ 5,000 A X Job Site Pollution PERSONAL&ADV INJURY $ 1,000,000 X Blanket Addtl Insd GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY PI PRO- LOC EO- AUTOMOBILE LIABILITY DT810754G611 STIL01 12/01/2001 12/01/2002 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) A X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident X Blanket Addtl Insd PROPERTY DAMAGE $ X Deductible Varies (Per accident GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY UMBRELLA/BINDER 12/01/2001 12/01/2002 EACH OCCURRENCE $ 5,000,000 X I OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 B $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 2288480 12/01/2001 12/01/2002 I WC ST ATU- I X I OTH- TORY LIMITS ER EMPLOYERS'LIABILITY E .EACH ACCIDENT $ 500,000 C E.L.DISEASE EA EMPLOYEE$ 500,000 E .DISEASE-POLICY LIMIT I$ 500,000 OTHER INLAND MARINE/BINDER 12/02/2001 12/02/2002 Limit $6,037,400;$2,500 Ded Contractors Equipment Limit $250,000;$2,500 Ded D Leased/Rented Equip DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: 2001 Slurry Seal Project Certificate Holder is named as Additional Insured under the General Liability as respects work performed by Named Insured. CERTIFICATE HOLDER I ADDITIONAL INSURED;INSURER LETTER'. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, The Board of Weld County Commissioners BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 915 10th St OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Greeley, CO 80632 AUTHORIZED REPRESENTATIVE id i Consie Hum, CISR/CAH ,tYYt,v.ct; - ACORD 25.5(7/97) ©ACORD CORPORATION 1988 £'Dd75e/,Y dael Cai `2?-1,,9 2001-3385 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(7/97) Hello