HomeMy WebLinkAbout20011567 ACORDTM CERTIFICATE OF LIABILITY INSURANCE Page 1 of 3 05/3DATE
1/2001
PRODUCER
87$=53$;-6"Y69,. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
- ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis North America, Inc. - Regional Cert Center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
11201 N. Tatum Boulevard l n ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 300 ,( _ r t 1� (Y J
Phoenix, AZ 85028 L. - " INSURERS AFFORDING COVERAGE
INSURED SRH Support Services, Inc. - INSURER A: Lumbermen Mutual Casualty Company
4801 Spring Valley Road �� - Pan Y (22977-002Y
Suite 1258 '—I L VINSURER B:
Dallas, TX 75244 INSURER C:
INSURER O:
INSURERE:
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 POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DOPYY) DATE/MM/DD/YY) LIMITS
A GENERALLIABIUTY 4L800190001 06/01/2001 06/01/2002 EACHOCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 50,000
CLAIMS MADE X OCCUR MEDEXP(Any one person) $ 5.040
PERSONALSADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEM.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000
POLICY PEA LOC
A AUTOMOBILE LIABILITY AOS F5D00842900 06/01/2001 06/01/2002
COMBINED SINGLE LIMIT $ 1,000,000
A X ANY AUTO TX F5D00843000 06/01/2001 06/01/2002 (6a acddenp
ALL OWNED AUTOS
BODILY
SCHEDULED AUTOS (Par Person)
$
X HIRED AUTOS
BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCEI $
OCCUR CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION $ S
A WORKERS COMPENSATION AND AOS 5BA12963401 06 WCCSTATU- OTH-
EMPLOYERS'LIABILITY /Dl/2DDl D6/Dl/2DD2 X TGRY LIMITS ER
A THE PROPRIETOR/ ND 5BA12963301 06/01/2001 06/01/2002 E.L.EACH ACCIDENT $ 1,000,000
PARTNERS/EXECUTIVE E.L.DISEASE-EA EMPLOYEE S 1,000,000
ARE: INCLUDED E.L.DISEASE-POLICY LIMIT $ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
All policies indicated are primary and non-contributory as respects any other
insurance in force.
It is a condition of the General Liability policy that the general aggregate
applies on a per project basis.
THIS CERTIFICATE OF LIABILITY INSURANCE MAY BE RELIED UPON ONLY IF THE ATTACHMENT REFERRED TO
HEREIN IS ATTACHED HERETO.
CERTIFICATE HOLDER I I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION Except 10 day. for Non-payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Board of County Commissioners of Weld County REPRESENTATIV .
915 Tenth Street AUTHORIZED P ENTATIVE
Greeley, CO 80632
ACORD2 3(7/97) Col1:71017 Tp1:13533 Cert:253203 ACORD CORPORATION 1988
Corse ciWiido
2001-1567
Page 2 of 3
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.
ACORD25S(7/97) Co11:71017 Tp1:13533 Cert:253203
Willis CERTIFICATE OF LIABILITY INSURANCE Page 3 of 3 05/3DATE
1/2001
PRODUCER 877-559-6769 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis North America, Inc. - Regional Cart Center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
11201 N. Tatum Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 300
Phoenix, AZ 85028 INSURERS AFFORDING COVERAGE
INSURED SRS Support Services, Inc. INSURER Lumbermen° Mutual Casualty Company
4801 Spring Valley Road Pan
Y (22977-002)
Suite 1258 INSURER B:
Dallas, TX 75244 INSURER C:
INSURER O:
INSURER E:
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
THIS ATTACHMENT MAY BE RELIED UPON ONLY IF THE CERTIFICATE REFERRED TO HEREIN IS ATTACHED HERETO.
Re: All operations of the insured during the Performance Period:
01 Jan 2001 through 31 Dec 2002
It is a condition of the General Liability, Automobile Liability and
Workers' Compensation policies that Weld County, Colorado and Weld County
Library Association are hereby added as additional insureds, only to the
extent assumed by the insured under the written contract, subject to the
policy terms, conditions and exclusions.
Coll:71017 Tp1:13533 Cart:253203
Hello