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AICORDIM CERTIFICATE OF INSURANCE o4%2�%00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
211 First Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Eaton, CO 80615 COMPANIES AFFORDING COVERAGE
970-454 -3381
COMPANY
AEMC Insurance Company
INSURED COMPANY
Little Thompson Water District BReliance National Insurance
Drawer G
COMPANY
835 E . Highway 56 C
Berthoud, CO 80513
COMPANY
D
COVERAGES. _.
THIS IS TO CERTIFY THAT 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 WITIH1 RESPECT TOVHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TQ ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR
DATE(MM/DDIYYI DATE(MM/DDNYI
A GENERAL LIABILITY BINDER167776 05/01/00 , 05/01/01 GENERAL AGGREGATE 1S2 , 000 , 000
X !COMMF RCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG y•$2 , 000 , 000
CLAIMS MADE 11 X OCCUR PERSONAL&ADV INJURY '-$1 , 000 , 000
OWNER'S&CONTRACTOR'S PROT I EACH OCCURRENCE $1 , 000 , 000
I I FIRE DAMAGE(Any one fire) $100 , 000
I MED EXP(Any one person) 6 , 000
A AUTOMOBILE LIABILITY BINDER167784 05/01/00 05/01/01
COMBINED SINGLE LIMIT $1 , 00(1 , 000
!I X ANY AUTO
ALL OWNED AUTOS I BODILY INJURY $
(Per person)
SCHEDULED AUTOSI
HIRED AUTOS BODILY INJURY $
NON OWNEDAUTOS (Per accident)
PROPERTY DAMAGE '$
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO I OTHER THAN AUTO ONLY:
I EACH ACCIDENT �i5
AGGREGATE IS _
A I 'EXCESS LIABILITY BINDER167786 05/01/00 05/01/01 EACH OCCURRENCE 55 , 000 , 000
I X � UMBRELLA FORM I AGGREGATE IIS5 , 0 00 , 0 0 0
I OTHER THAN UMBRELLA FORM _-
B I WORKERS COMPENSATION AND NWX6006564 ' 07/01/99 07/01/00 X 'I STATUTORYLIMITS
EMPLOYERS'LIABILITY EACH ACCIDENT 5100 , 0°0
THE PROPRIETOR/ INCL DISEASE-POLICY LIMIT 600 , 000
PARTNERS/EXECUTIVE 1
OFFICERS ARE. EXCL DISEASE-EACH EMPLOYEE$100 , 000
--'OTHER -- -
DESCFIIPTON OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Fax: 970-352-2868
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Weld County - Engineering EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Attn: Don Summer 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
P 0 Box 738 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Greeley, CO 80632 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
O5-o8•avoo
, �' Rood,, f�efeisan riiSCc/a P7-e'O -2.-Ala _
ACORD 28•S(3193)1 of 1 #S151815/M151807 DLB
2000-1227
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