HomeMy WebLinkAbout20013338.tiff ACORD CERTIFICATE OF LIABILITY INSURANCkEID
R RC DATE IMM/DD/YY)
BRTH-5 11/28/01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Linden/Bartels & Noe Agency-FC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Fort Collins HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
2900 South College Ave Ste. 2A ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW.
Fort Collins CO 80525
Phone: 970-229-9304 Fax:970-229-1398 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Employers Mutual
INSURER B: Pinnacol Assurance
Town Of Berthoud INSURER C:
P.O. Box 1229 INSURER D:
Berthoud CO 80513
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 POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER
DATE(MMIDD/1'Y) DATE(MMIDDNY) LIMBS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
A X COMMERCIALGENERALLIABILITY 0D9947902 09/01/01 09/01/02 FIREDAMAGE(Anyonefire) $100,000
CLAIMS MADE X OCCUR MED EXP(My one person) $ 5,000
PERSONALBADV INJURY $ 1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
POLICY n PRO-
JECT - LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $ 600,000
A X ANY AUTO 0E9947902 09/01/01 09/01/02 (Ea accident)
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS $
(Per person)
X HIRED AUTOS
BODILYX NON-OWNED AUTOS (Per accident)INJUt $
PROPERTY DAMAGE $
(Per acddent)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO
OTHER THAN ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE
$
RETENTION $ $
WORKERS COMPENSATION AND X TORY LIMIT S OER
B EMPLOYERS'LIABILITY 0016385 01/01/02 01/01/03 E.L.EACH ACCIDENT $ 100,000 _
E.L.DISEASE-EA EMPLOYEE $ 100,000
E.L.DISEASE-POLICY LIMIT $ 500,00 0
OTHER
A Crime/Dishonesty 0L9947902 09/01/01 09/01/02 Limit $100,000
Ded $250
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
All Operations - All Locations. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL
INSURED.
CERTIFICATE HOLDER I N ADDITIONAL INSURED;INSURER LETTER:_ CANCELLATION
WELD-09 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
WELD COUNTY IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
915 10TH ST. REPRESENTATIVES.
GREELEY CO 80631' - )
Michael D. Pierce ) - -
ACORD 25-S(7 Ilit3p1ew- 45 ,j1RD CORPORATION 1988
0 '79__J0 7 2001-3338
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