HomeMy WebLinkAbout20001170.tiff INSURANCE IS PROVIDED BY THE COMPANY DESIGNATED BY AN X
OfRTIOfRL FRRITIERS union 11900 East Cornell Avenue
PROPERTY Rn° CRSURLTY COMPRI-1V
x f1RTIOf1RL FRRITERS unionAurora, Colorado 80014-3194
STRflDRRD InSURRIlCE COfT1PRflY (303) 337-5500
UMBRELLA POLICY
***DECLARATIONS***
ITEM 1. NAME OF INSURED AND ADDRESS: Customer# : CO-8080218
Wiggins Telephone Association Policy # 2CB0159480
P.O. Box 690 Agent # SA005996
Wiggins, CO 80654-0690 P/A 52
ITEM 2. ADVANCE PREMIUM: $ 2,200 payable per annum.
Minimum Premium: $ 800 in event of cancellation.
ITEM 3. POLICY PERIOD: FROM: January 1, 2000 TO: January 1, 2001
12:01 AM Standard Time at the address shown in ITEM 1.
ITEM 4. LIMIT OF INSURANCE:
A. $ 10,000 Self-Insured Retention.
B. $ 5,000,000 Each Occurrence & Policy Aggregate Limit where applicable.
ITEM 5. SCHEDULE OF UNDERLYING INSURANCE:
Type & Policy Number Underlying Insurer Policy Period Limit(s) of Insurance
RUIP National Farmers Union 1/1/2000 to 1/1/2001 $1,000,000 CSL GEN LIAB
2RU0159479 Standard Insurance
$2,000,000 Prod-Comp
Company Operations Aggregate
$1,000,000 CSL AUTO LIAB
WORK COMP National Farmers Union 1/1/2000 ASSEmployers Liability
2WC0159482 Standard Insurance BI by Accident
Company $100,000 each Accident
BI by Disease
$500,000 Policy Limit
$100,000 each Employee
ITEM 6. ENDORSEMENTS ATTACHED AT INCEPTION: PG 136(3/93) , PG 590(5/98) , PG 413(3/93) ,
Special Endorsement 111.
01/18/00 JW
O s j- ar""A' 2000-1170
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PG-221 (3/93) Authoriz R Date
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