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AjCORa CERTIFICATE OF LIABILITY INSURANCE o4i(z�,00
PRODIJCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins . Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. 0. 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 INSURERS AFFORDING COVERAGE
INSURED INSURER A:Northland Ins . Co. /Dann Ins .
Les Matson Construction Inc .
INSURER B:
P.O. Box 1830
INSURER C:
Greeley, CO 80632
INSURER D
I 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.
7 TYPE OF INSURANCE _.. _ NUMBER _
INSR PDATE( FFECTIVE POLICY EXPIRATION
POLICY DATE lMM/DD/YYl DATE(MM/DD/YYI LIMITS
A GENERAL LIABILITY -I�l RC100079 03/17/00 03/17/01 I EACH OCCURRENCE i$1, 0 0 0 , 0 0 0
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one ire $50 , 000
CLAIMS MADE X OCCUR,1 MED EXP(Any one person) $Excluded
, III PERSONAL BADV INJURY $1, 000 , 000
I I GENERAL AGGREGATE 52 , 000 , 000
CEN'L AGGREGATE LIMITAPPLIESPER: ' PRODUCTS-COMP/OF'AGG $2 , 000 , 000
POLICY, : 28t LOC
A AUTOMOBILE LIABILITY RC100079 ' 03/17/00 03/17/01 COMBINED SINGLE LIMIT $l, OOH 000
X ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
X HIRED AUTOS BODILY INJURY
(Per accident)
$
x NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
•
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
•
ANY AUTO - OTHER THAN EA ACC $
I I AUTO ONLY: AGG $
A EXCESSLIABILITY RC100080 03/17/00 03/17/01 EACH OCCURRENCE $1, 000 , 000
XI OCCUR CLAIMS MACE AGGREGATE I
51. , 000 , 000
$
I DEDUCTIBLE _... __.
1 g
XI RETENTION $10000 I$
WORKERS COMPENSATION AND TORY?MT41___CiEnER 1
EMPLOYERS'LIABILITY
I E.L.EACH ACCIDENT $
E.L.DISEASE-EA EMPLOYEE,$
1 E.L.DISEASE-POLICY LIMIT$
A OTHER Inland IRC100079 03/17/00 , 03/17/01. $2 , 000 , 000 Blanket
larine limit
$1, 000 deductible
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER ADDmoNALINSUREDpNSURER LETTER: CANCELLATION
SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATON
Weld County Public Works DATETHEREOF,THE ISSUING INSURER WILLENDEAVORTO MAI L3 0 DAYSWRITTEN
P.O . Box 758 NOTICETOTHE CERTIFICATE HOLDER NAMEDTOTI-E LEFT,BUTFAILURE TO DO SO SHALL
Greeley', CO 80632 IMPOSE NO O LIGATION OR LIABILITY OF ANYKIN E6P\DN THE INSURER,ITS AGE NTS OR
REP))VIpESE ATIVE
AU IZED REP ESENTA�E I--7" /L....," /'
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ACOIr25-S(7/97I1 of 2 #S151733/M150095 KFP @AI
C a-nai�' 'c-, 0,5-O3-,ao3o 2000-1224
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