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ACORD,a CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY)
02/24/00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins . Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. O. BOX 578 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W. 18th Street
Greeley, CO 80632 :?i INSURERS AFFORDING COVERAGE
INSURED INSURER A:TITAN INSURANCE COMPANY
North Weld County Water District, INSURER B:Pinnacol Assurance
33247 Highway 85
P O Box 56 INSURER 0:
INSURER D:
Lucerne, CO 80646 -
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 TE(MLAECTIVE POLICY EXPIRATION TYPE POLICY NUMBER DATE(MMIDD/YY) DATE fMM/DD/Y11 LIMITS
A GENERAL LIABILITY 99HP03857 02/25/00 02/25/01 EACH OCCURRENCE $1, 000 000
r IX COMMERCIALGENERALLIABILITY FIRE DAMAGE(Any one fire)$1, 000,00.0_
1 CLAIMS MADE X1 OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $1, 000, 000
GENERAL AGGREGATE $2 , 000, 000
GENII OATELIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $2, 00 0 f 000
PRO-
POLICYI -I JECT - - -
LOC
A I AUTOMOBILE LIABILITY99HP03857 02/25/00 02/25/01 COMBINED SINGLE LIMIT $1, 000
ANY AUTO (Ea accident)
, 000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS I (Per person) $
HIRED AUTOS
BODILY INJURY
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO
' OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE '$
OCCUR CLAIMS MADE 'AGGREGATE_ $
DEDUCTIBLE
$
RETENTION $ $
B :WORKERS COMPENSATION AND 34315 01/01/00 101/01/01 WCSTATU- �' 0TH-
EMPLOYERS'LIABILITY
E.L.EACH ACCIDENT $1001,000
E.L_DISEASE-EA EMPLOYE $100, 000
E.L.DISEASE-POLICY LIMI $500, 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY EN DORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER ADDmONALINSURED;INSURER LETTER CANCELLATION
SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Weld County-Utilities Inspector DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAIL3 0 DAYS WRITTEN
PO Box 756 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DOSO SHALL
Greeley, CO 80632 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Flood/ Pele.j on -Zn&aance , -na-
ACORD25-S(7197)1 of 2 #5147476/M147470 CCN
C- A. 3-/-A000 2000-0527
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