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• Of CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD//Y, ,`.
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS °' ,':�
NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND ' -'-...-
':x
-"END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. E":v.'
PENCO
PO Box 305107 -.I
COMPANIES AFFORDING COVERAGEI
Nashville, TN 37230-f107 CC AN - A � .""
L R NORTHLAND INSURANCE COMPANY
— iii- ii,
e : ANY
INSURED iii:-I-R a 'Ot
Colorado IngeAgncCIRSA M C $ .
Risk Sharing Agency (CIRSAI R
950 South Cherry Street, 1800 LlI AN D xK
Denver, CO 80222 LE.• II R
TEL: 13031 757-5475 FAX: (303) 15'-31-0 c OMPAN, °.
TOWN OF KERSEY LEI E f/.
COVERAGES Ntc
THIS IS TO CERTIFY THAT 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 -,...I'
BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS. AND CONDI—
•9.^.,-" TIONS OF SUCH POLICIES. .i
CO POLITY—I:L COVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS t;E.,
TYPE OF INSURANCE POLICY R NUMBE
LTR DA—E MM/Dams PATE(MOONY) EACH AGGREGATE �4
CCCURRENCF RIB
GENERAL LIABILITY IBODILY
AON REHENSIVE FORM AA01140 01./01/200] 01/0112002 FINJURY $ $ ,:
PREMISES/OPERATIONS 'PROPERTY
UNDERGROUND 'DAMAGE $ $
EXPLOSION a COLLAPSE HAZARD ____
PRODUCTS/COMPLETED OPERATIONS 2,
CONTRACTUAL COMBDED $ * $ '
INDEPENDENT CONTRACTORS—
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY PERSONAL INJURY $ ,
r.)
AUTOMOBILE LIABILITY I EL ,
I CUP?
ANYXAUTO AA61'L40 01/01'2001 01/01'2002 IFFEFPASDNI $ 3,
ALL OWNED AUTOS(PRIV. PASS-, 5QTL. f.,
OTHER THAN bin?
ALL OWNED AUTOS(PRIV. PASS ) IPF,ACCIDENT) $
HIRED AUTOS
PROPERTY 'r1,
NON OWNED AUTOS DAMAGE $
GARAGE LIABILITY
BI 8 PO •Cz
COMBINED $ * Vti
EXCESS LIABILITY
UMBRELLA FORM
COMBINED $ $ .;
OTHER THAN UMBRELLA FORM "`"'
STATUTORY I ''1
WORKERS'COMPENSATION
AND $ (EACH ACCIDENT) YHhi
$ (DISEASE-POLICY LIMIiI
EMPLOYERS' LIABILITY
$ (DISEASE-EACH EMPLOYEE)
OTHER
°
aDESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
* See Attached Schedule for Coverage and Carriers
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As respects law enforcement agreement covering activities of 4-
• 2001-0392 .
CERTIFICATE HOLDER CANCELLATION :-
Additional Insured: Certificate No: 3854 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX. ( -,4
PIRATICN DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO '
WELD COUNTY COMMISSIONERS MAIL 1II DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
P 0 758 LEFT,BUT FAILURE TO MAIL SUC OTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY T
OF ANY KIND UPON THE COM: Y, ITS AG 0 PRES T. I ES. ,y
GREELEY, CO 80632 AUTHORIZED REPRESENTATIVE d fl•a t t 1
ACORD Y6 (9/6,4) ,) IIR/ACORD CORPORATION 1984.1.1%14
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