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/ ARTHUR J. GALLAGHER & CO.-DENVER
4643 So. Ulster Street, Suite 280, Denver, Colorado 80237
P.O. Box 24809, Denver, Colorado 80224
303/773-9999
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DATE SIGNED
GA-USS-DE
RETURN TO ORIGINATOR
___. . _-
ORIGINAL
III, CH'✓230/186
• ISL 3456
Lloyd ' s Policy
/OE NTIt` I
Whereas the Assured named in the Schedule herein has paid the
premium specified in the said Schedule to the Underwriting Members of Lloyd's
who have hereunto subscribed their Names (hereinafter referred to as "the
Underwriters''),
NOW Know Ye that We, the Underwriters, Members of the
Syndicates whose definitive numbers in the aftermentioned List of Underwriting
Members of Lloyd's are set out in the attached Table, hereby bind ourselves each
for his own part and not one for another, our Heirs, Executors and Administrators,
and in respect of his due proportion only, to insure against any loss as more fully
specified herein, whether a total or partial loss, as well as associated costs specified
herein, if any, which shall be substantiated under this Policy, to the extent and
in the manner hereinafter provided.
If the Assured shall make any claim knowing the same to be false or fraudulent,
as regards amount or otherwise, this Policy shall become void and all claim
hereunder shall be forfeited.
In Witness whereof the General Manager of Lloyd's Policy Signing
Office has subscribed his name on behalf of each of Us.
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7 - LLOYD'S POLICY SIGNING OFFICE • •
i p General Manager
La e
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o
J(A) NMA 2214 Form approved by Lloyd's Underwriters'Nor Marine Association_ L
Printed by The Carlton Berry Co Ltd. ICY SIGN
SERVICE OF SUIT CLAUSE (U.S.A.) • `
It is agreed that in the event of the failure of the Underwriters hereon to pay any amount claimed to be due
hereunder. the I inderwriterc hereon at the rermect of'the incrrreA L,.r noi,.ciwneD µ,ill submit to the jurisdiction
Clause constitutes or should
U.S.A. ion in any Court of competent
NUCLEAR INCIDENT EXCLUSION CLAUSE—LIABILITY—DIRECT(BROAD) ,t Court, or to seek a transfer
(Approved by Lloyd's Underwriters'Non-Marine Association) p State in the United States.
for artachmenl to insurances of the following classifications in the U.S.A., its Territories and y
Possessions, Puerto Rico and the Canal Zone:—
Owners, Landlords and Tenants Liability, Contractual Liability, Elevator Liability, Owners
or Contractors (including railroad) Protective Liability, Manufacturers and Contractors
Liability, Product Liability, Professional and Malpractice Liability, Storekeepers Liability, , and
Garage Liability, Automobile Liability (including Massachusetts Motor Vehicle or Garage niters will abide by the final
Liahilinq,
not being insurances of the classifications to which the Nuclear Incident Exclusion Clause—Liability—
Direct(Limited/applies.
)ehalf of Underwriters in any
I his poky, sit undertaking to the Insured
does not apply— ehalf in the event such a suit
L l nder amt lability(.o‘erage.,to injury,..ickness,disease death or destruction `
(a) with respect to which an insua ed under the policy is also an insured under a nuclear energy
liability policy issued by Nuclear Energy I.lability Insurance Association. Mutual Atomic '(
Energy I.lability Underwriters or Nuclear Insurance Association of Canada, or would he an
toured under any such policy but for its termination upon exhaustion of its limit of liability,or ≥fates which makes provision
(hi resulting from the hazardous properties of nuclear material and with respect to which 111 any
person or organization is required to maintain financial protection pursuant to the Atomic oner or Director of Insurance
Energy Act of 1954,or any law amendatory thereof,or(2)the insured is,or had this policy not successors in office, as their
been issued would he.entitled to indemnity from the united Slates of America,or any agency
thereof, tinder any agreement entered into by the United Slates of America,or any agency ly action, suit or proceeding
th rwf with any person or organization.
I1. Coder any Medical Payments Coverage. or under any Supplementary. Payments PrOliSiOll relating to ter arising out of this contract
immediate medical or surgical relief,to expenses incurred with respect to bodily injury sickness,disease
or death resulting from the hazardous properties of nuclear material and arising out of the operation of a 'son to whom the said officer
nuclear facility by any person or organization.
II1. tinder any Liability Coverage, to injury, sickness, disease. death or destruction resulting from the
hazardous properties of nuclear material,if
la) the nuclear material 11)is at any nuclear facility owned by,or operated by or on behalf of,an
inatrod nrtnihas hevo Ainharord'w'in "'.d tho.otr.....
U.S.A.
RADIOACTIVE CONTAMINATION EXCLUSION CLAUSE; 1 -
PHYSICAL DAMAGE—DIRECT 1.
(Approved by Lloyd's Underwriters'Non-Marine Association)
This policy does not cover any loss or damage arising directly or indirectly from nuclear
reaction nuclear radiation or radioactive contamination however such nuclear reaction
nuclear radiation or radioactive contamination may have been caused* NEVERTHELESS if
Fire is an insured peril and a Fire arises directly or indirectly from nuclear reaction nuclear
radiation or radioactive contamination any loss or damage arising directly from that Fire
U.S.A
RADIOACTIVECONTAMINATION EXCLUSION CLAUSE—LIABILITY--DIRECT
(Approved by Lloyd's Underwriters'Non-Marine Association)
For attachment (in addition to the appropriate Nuclear Incident Exclusion Clause—Liability—
Direct)to liability insurances affording worldwide coverage.
In relation to liability arising outside the U.S.A., its Territories or Possessions, Puerto Rico or the
Canal Zone,this Policy does not cover any liability of whatsoever nature directly or indirectly caused by
or contributed to by or arising from ionising radiations or contamination by radioactivity from any
nuclear fuel or from any nuclear waste from the combustion of nuclear fuel.
13/2/64
N.M.A. 1477
unda-riineds .... to de ............._.,..... vera ,.e_.,_.._.,,.,.. ,.,.,.,...,napp,.F.... .......,.,.,
tned should be amended designate the liability coverage to which this clause is to apply.
17/3/60
N.M.A. 1256
Schedule
Policy or Certificate No. GHV 230 / 186 Contract No. (if any)
The name and address of the Assured
Weld County, Colorado, Including any Officer, Servant or
Employee of the Named Assured, any member of the Governing
Boards or Commissions of the Named Assured,
915 10th Street,
Greeley, CO 80631 .
The risk, interest, location and sum insured hereunder
EXCESS ALL RISKS OF PHYSICAL LOSS OR DAMAGE and as more particularly defined
in Endorsement Number 1 attaching hereto.
Subject to the NMA Lines Clause attaching hereto.
NMA LINES CLAUSE
For attachment to Insurances where Lloyd's Underwriters' subscription is less than 100%.
THIS INSURANCE, being signed for 90.00%, insures ONLY ITS PRO RATA PROPORTION of
i) any loss as more fully specified herein, whether total or partial, and
ii) associated costs, if any, as more fully specified herein.
The percentages signed in the Table are percentages of the amount(s) of Insurance stated herein.
N.M A 1992 Form approved by Lloyd's underwriters'Non-Marine Assocmuon. Panted by The Carlton Berry Co. Ltd.
The Premium US$55,647 part of US$61 ,830 being pro rata for the period.
The period af Insurancefrom 15th January, 1986 tol st July, 1986
Az a.m. Local Standard Time
both days inclusive s ' and or such urt er peno or periods as may be mutually agreed upon
xxxxDated in London the26th January, 1987.
J or J(A) (Schedule) NMA 2215 for attachment to NMA 2213, NMA 2214, NMA 2216 or NMA 2217
x
ENDORSEMENT attaching to and forming part of Policy No. GHV 230/186
in the name of Weld County, Colorado, et al .
Effective date of this endorsement is 15th January, 1986 Endorsement No. 14
It is noted and agreed effective inception coverage is extended to include
Useful Public Servants, but only in respect of their operations whilst working
on behalf of the Assured.
All other terms and conditions remain unchanged.
0631W
ENDORSEMENT attaching to and forming part of Policy No. GHV230/186
in the name of Weld County, Colorado, et al.
r Effective date of this endorsement is January 15, 1986 Endorsement No. 13
It is noted and agreed effective inception volunteers are covered under the Workers'
Compensation coverage but only with respect to operations by or on behalf of the Named
Assured.
Subject otherwise to all terms, clauses and conditions as heretofore.
ENDORSEMENT attaching to and forming part of Policy No. GHV23O/186
in the name of WELD COUNTY. COLORADO etal
Effective date of this endorsement is 15th January 1986 Endorsement No. 12
ABSOLUTE ASBESTOS EXCLUSION
Notwithstanding anything to the contrary contained in this Policy, it is
hereby understood and agreed that this Policy shall not apply to:-
Bodily Injury or Personal Injury or loss of, damage to or loss
of use of property directly or indirectly caused by asbestos.
Subject otherwise to all terms, clauses and-,conditions as heretofore.
1005/0379W
ENDORSEMENT attaching to and forming part of Policy No. CH✓✓230✓186
in the name of Weld County, Colorado, et al.
Effective date of this endorsement is January 15, 1986 Endorsement No. 11
INVERSE CONDEMNATION EXCLUSION CLAUSE
This policy does not cover claims for loss or damage or any liability of any and all the Assureds arising
out of or in any way connected with the operation of the principles of eminent domain, condemnation
by whatever name called regardless of whether such claims are made directly against the Assured or
by virtue of any agreement entered into by or on behalf of the Assured.
Subject otherwise to all terms, clauses and conditions as heretofore.
ENDORSEMENT attaching to and forming part of Policy No. GH'✓233/186
in the name of Weld County, Colorado, et al.
Effective date of this endorsement is January 15, 1986 Endorsement No. 10
It is hereby understood and agreed that this Policy shall not apply to liability arising out of
Hospital/Clinic Malpractice.
Subject otherwise to all terms, clauses and conditions as heretofore.
I
1
ENDORSEMENT attaching to and forming part of Policy No. GHV23J/186
in the name of Weld County, Colorado, et al.
Effective date of this endorsement is January 15, 1986 Endorsement No. 9
SEXUAL MISCONDUCT EXCLUSION
Sexual or physical abuse or molestation of any person by the Assured, any employee of the
Assured or any volunteer worker does not constitute personal injury within the terms of
this policy and as such any claim arising, directly or indirectly, from the aforementioned is
excluded.
Subject otherwise to all terms, clauses and conditions as heretofore.
ENDORSEMENT attaching to and forming part of Policy No. GHV230/186
in the name of Weld County, Colorado, et al.
Effective date of this endorsement is January 15, 1986 Endorsement No. 8
SEEPAGE OR POLLUTION OR CONTAMINATION
AND
DEBRIS REMOVAL AND COST OF CLEAN UP
ENDORSEMENT
SEEPAGE OR POLLUTION OR CONTAMINATION EXCLUSION
Notwithstanding anything to the contrary contained in the Policy to which this Endorsement is
attached this Policy does not insure against loss, damage, costs, fines, penalties or expenses directly
or indirectly consequent upon:-
seepage or pollution or contamination from any cause.
DEBRIS REMOVAL AND COST OF CLEAN UP EXTENSION
Notwithstanding anything to the contrary contained in the Policy to which this Endorsement is
attached, in the event of direct physical loss or damage to the property covered hereunder, this Policy
also insures, within the sum insured
a) expenses incurred in removal from the premises of the Assured of debris of the insured
property destroyed or damaged
and/or
b) cost of clean up, at the premises of the Assured, made necessary as a result of such loss or
damage.
It is a condition precedent to recovery under this extension that Underwriters shall have paid or
agreed to pay for physical loss or damage and that the Assured shall give notice to the Underwriters
of intent to claim for cost of removal of debris or cost of clean up NO LATER THAN 12 MONTHS
AFTER THE DATE OF SUCH PHYSICAL LOSS OR DAMAGE.
io3onan.86
AUTHORITIES EXCLUSION
This Policy does not cover expenses, fines, penalties or costs incurred or sustained by the Assured or
imposed on the Assured at the order of any Government Agency, Court or other Authority, in
connection with any kind or description of environmental impairment including seepage or pollution or
contamination from any cause.
Subject otherwise to all terms, clauses and conditions as heretofore.
1030 Jan B6
ENDORSEMENT attaching to and forming part of Policy No. GHV23D/186
in the name of Weld County, Colorado, et al.
Effective date of this endorsement is January 15, 1986 Endorsement No. 7
VALUABLE PAPERS AND RECORDS EXTENSION
1. PROPERTY COVERED: Underwriters agree to pay in respect of loss or damage to valuable
papers and records, (hereinafter referred to as 'property').
2. THIS EXTENSION INSURES AGAINST: All risks of direct Physical Loss of or damage to the
property covered, except as hereinafter provided, occurring during the period of the Policy to
which this Extension is attached.
3. PROTECTION OF VALUABLE PAPERS AND RECORDS: Insurance under this Extension shall
apply only while the property is contained in the premises of the Assured, and shall be kept in
protective receptacle(s) at all times when the premises are not open for business, except while
such property is in actual use.
4. AUTOMATIC EXTENSION: Such insurance as is afforded by this Extension applies while the
property is being conveyed outside the premises and while temporarily within other premises,
except for storage, provided Underwriters liability for such loss or damage shall not exceed ten
percent of the combined limits of Insurance stated in the Declarations, nor Fifty Thousand
Dollars, whichever is less.
5. REMOVAL: Such insurance as is afforded by this Extension applies while the property is being
removed to and while at a place of safety because of imminent danger of loss and while being
returned from such place, provided the Assured gives written notice to Underwriters of such
removal within ten days thereafter.
EXCLUSIONS
THIS EXTENSION DOES NOT APPLY;
1.. to loss or damage due to wear and tear, gradual deterioration, vermin or inherent vice;
2. to loss or damage due to any dishonest, fraudulent or criminal act by any Assured, a Partner
therein or an Officer, director or Trustee thereof, whether acting alone or in collusion with
others;
3. to loss of or damage to property, if such property cannot be replaced with other of like kind or
quality;
1036/Jan 86 Page 1 of 3
4. to loss of or damage to property held as samples or for sale or delivery after sale;
5. to loss due to electrical or magnetic injury, disturbance or erasure of electronic recordings,
except by lightning;
6. to war risks or nuclear risks as excluded in the Policy to which this Extension is attached.
SPECIAL CONDITIONS
1. Definitions: 'Property' means written, printed or otherwise inscribed documents and records,
including books, maps, films, drawings, abstracts, deeds, mortgages and manuscripts, but does
not mean money or securities.
'Premises' means the interior of that portion of the building which is occupied by the
Assured for business operations.
'Money' means currency, coins, bank notes and bullion; and travellers checks, register
checks and money orders held for sale to the public.
'Securities' means all negotiable and non-negotiable instruments or contracts representing
either money or other property and includes revenue and other stamps in current use, tokens and
tickets, but does not include money.
2. Ownership of Property: Interests Covered
The insured property may be owned by the Assured or held by him in any capacity; provided, the
Insurance applies only to the interest of the Assured in such property, including the Assured's
liability to others, and does not apply to the interests of any other person or organization in any
of said property unless included in the Assured's proof of loss.
3. Limits of Liability; Valuation; Settlement Option
The limit of Underwriters liability for loss shall not exceed the actual cash value of the property
at time of loss nor what it would then cost to repair or replace the property with other of like
kind and quality, nor the applicable limit of Insurance. The Underwriters may pay for the loss in
money or may repair or replace the property and may settle any claim for loss of the property
either with the Assured or the Owner thereof.
Application of the Insurance to property of more than one person shall not operate to increase
the applicable limit of Insurance.
4. Assured's Duties When Loss Occurs
Upon knowledge of loss or of an occurrence which may give rise to a claim for loss, the Assured
shall:
(a) give notice thereof as soon as practicable to the Underwriters or any of its authorized
Agents and, if the loss is due to a violation of law, also to the Police;
(b) file detailed proof of loss, duly sworn to, with the Underwriters promptly upon the
expiration of ninety days after the discovery of loss.
1036'lan.86 Page 2 of 3
Upon the Underwriters request, the Assured shall submit to examination by the Underwriters,
subscribe the same, under oath if required, and produce for the Underwriters' examination all
pertinent records, all at such reasonable times and places as the Underwriters shall designate,
and shall cooperate with the Underwriters in all matters pertaining to loss or claims with
respect thereto.
'Underwriters shall, in addition to the applicable limit of liability of this Extension, reimburse
the Assured for all reasonable expenses, other than loss of earnings, incurred at Underwriters'
written request'.
5. Changes
Notice to any representative or knowledge possessed by any representative or by any other
person shall not effect a waiver or a change in any part of this Extension or estop Underwriters
from asserting any right under the terms of this Extension nor shall the terms of this Extension
be waived or changed, except by endorsement issued to form a part of this Extension.
Subject otherwise to all terms, clauses and conditions as heretofore.
ENDORSEMENT attaching to and forming part of Policy No. GHV230/186
in the name of Weld County, Colorado, et al.
Effective date of this endorsement is January 15, 1986 Endorsement No. 6
In consideration of the premium charged, it is hereby understood and agreed that the
Policy is extended to afford Personal Injury Protection coverage in accordance with
standard Endorsement C2203 (Ed 01-85) statutory benefits but not exceeding all third
party sublimits in current use on the aforementioned date.
Subject otherwise to all terms, clauses and conditions as heretofore.
ENDORSEMENT attaching to and forming part of Policy No. GHV230/186
in the name of Weld County, Colorado, et al.
Effective date of this endorsement is January 15, 1986 Endorsement No. 5
ACCOUNTS RECEIVABLE EXTENSION
INSURING CLAUSE
In consideration of the premium paid and subject to the terms, conditions and exclusions of the policy
to which this Extension is attached, and to the following terms, conditions and exclusions, this
insurance is extended to cover:
1. SUBJECT OF INSURANCE
A. All sums due to the Assured from customers', provided the Assured is unable to effect
collection thereof as the direct result of loss of or damage to records of accounts receivable;
B. Interest charges on any loan to offset impaired collections pending repayment of such sums
made uncollectible by such loss or damage;
C. Collection expense in excess of normal collection cost and made necessary because of such loss
or damage;
D. Other expenses, when reasonably incurred by the Assured in re-establishing records of accounts
receivable following such loss or damage.
2. PERILS INSURED
All Risks of Direct Physical Loss or Damage to the Assured's records of accounts receivable occurring
during the period of the policy to which this extension is attached, except as hereinafter provided.
PERILS EXCLUDED
This Extension does not insure against:-
1. loss due to any fraudulent, dishonest or criminal act by any Assured, a Partner therein, or an
Officer, Director or Trustee thereof, whether acting alone or in collusion with others;
2. loss due to bookkeeping, accounting or billing errors or omissions;
3. loss, the proof of which as to factual existence, is dependent upon an audit of records or an
inventory computation; but this shall not preclude the use of such procedures in support of claim
for loss which the Assured can prove, through evidence wholly apart therefrom, is due solely to
a risk of loss to records of accounts receivable not otherwise excluded hereunder;
1001/Jan_86 Page 1 of 3
4. loss due to alteration, falsification, manipulation, concealment, destruction or disposal of
records of accounts receivable committed to conceal the wrongful giving, taking, obtaining or
withholding of money, securities or other property but only to the extent of such wrongful
giving, taking, obtaining or withholding;
5. loss due to electrical or magnetic injury, disturbance or erasure of electronic recordings, except
by lightning.
6. to war risks or nuclear risks as excluded in the Policy to which this Extension is attached.
SUM INSURED
The Underwriters hereon shall not be liable under this Extension for more than the respective sum
insured stated in the Declarations in respect of each loss or series of losses arising out of one event.
CONDITIONS
1. RECOVERIES
After payment of loss, all amounts recovered by the Assured on accounts receivable for which
the Assured has been indemnified shall belong and be paid to the Underwriters by the Assured up
to the total amount of loss paid by the Underwriters; but all recoveries in excess of such
amounts shall belong to the Assured.
2. ASSURED'S DUTIES UPON OCCURRENCE OF LOSS
Upon the occurrence of any loss which may result in a claim hereunder, the Assured shall:
A. give notice thereof as soon as practicable to the Underwriters or any of their authorized agents
and, if the loss is due to a violation of law, also to the police;
B. file detailed proof of loss, duly sworn to, with the Underwriters promptly on expiration of ninety
days from the date on which the records of accounts receivable were lost or damaged.
Upon the Underwriters request, the Assured shall submit to examination by the Underwriters,
subscribe the same, under oath if required, and produce for the Underwriters' examination all
) pertinent records, all at such reasonable times and places as the Underwriters shall designate, and
shall cooperate with the Underwriters in all matters pertaining to loss or claims with respect thereto,
including rendering of all possible assistance to effect collection of outstanding accounts receivable.
3. DETERMINATION OF RECEIVABLES: DEDUCTIONS
When there is proof that a loss covered by this Extension has occurred but the Assured cannot
accurately establish the total amount of accounts receivable outstanding as of the date of such
loss, such amount shall be based on the Assured's monthly statements and shall be computed as
follows:-
A. determine the amount of all outstanding accounts receivable at the end of the same fiscal
month in the year immediately preceding the year in which the loss occurs;
B. Calculate the percentage of increase or decrease in the average monthly total of accounts
receivable for the twelve months immediately preceding the month in which the loss occurs, or
1ootnan 86 Page 2 of 3
such part thereof for which the Assured has furnished monthly statements to the Underwriters
as compared with such average for the same months of the preceding year;
C. the amount determined under (A) above, increased or decreased by the percentage calculated
under (B) above, shall be the agreed total amount of accounts receivable as of the last day of
the fiscal month in which said loss occurs;
D. the amount determined under (C) above shall be increased or decreased in conformity with the
normal fluctuations in the amount of accounts receivable during the fiscal month involved, due
consideration being given to the experience of the business since the last day of the last fiscal
month for which statement has been rendered.
There shall be deducted from the total amount of accounts receivable, however established, the
amount of such accounts evidenced by records not lost or damaged, or otherwise established or
collected by the Assured, and an amount to allow for probable bad debts which would normally have
been uncollectible by the Assured. All unearned interest and service charges shall be deducted.
III
Subject otherwise to all terms, clauses and conditions as heretofore.
ENDORSEMENT attaching to and forming part of Policy No. GHV230/186
in the name of Weld County, Colorado, et al.
Effective date of this endorsement is January 15, 1986 Endorsement No. 4
In consideration of the premium charged, it is hereby understood and agreed that the following
Insuring Agreement J - Faithful Performance is incorporated in SECTION III - CRIME INSURANCE:-
AGREEMENT J - FAITHFUL PERFORMANCE: Underwriters agree, subject to the terms and
conditions set forth herein, to indemnify the Assured for loss caused to the Assured through failure of
any of the Assured's employees as defined, acting alone or in collusion with others, to perform
faithfully his duties or to account properly for all monies and property received by virtue of his
position of employment.
Subject otherwise to all terms, clauses and conditions as heretofore.
ENDORSEMENT attaching to and forming part of Policy No. GHV 230/186
in the name of Weld County, Colorado, et al .
Effective date of this endorsement is 15th January, 1986 Endorsement No. 3
EXTRA EXPENSE
40/80/100% of LIMIT
It is agreed that if the property insured by Insuring Agreement A of Section 1
is damaged or destroyed by perils insured against in said Insuring Agreement A
during the period of this Insurance so as to necessitate the incurrence of
Extra Expense (as defined below) the Underwriters shall be liable for the
Extra Expense so incurred, not exceeding the actual loss sustained, for not
exceeding such length of time, hereinafter referred to as the "period of
restoration" .
It is further agreed that this extension in coverage shall not operate to
increase the Underwriters limits of liability hereunder.
Underwriters shall be liable for no greater percentage of the amount of the
sub limit as contained in General Insurance Agreement IV (c) of this Policy
than is stated below for the determined period of restoration.
40% if period of restoration is not in excess of one month;
80% if period of restoration exceeds one month but does not exceed two
months;
100% if period of restoration exceeds two months.
Page 1 of 3
DEFINITIONS
(a) Extra Expense: The term "Extra Expense" means the excess (if any) of
the total cost incurred during the period of restoration chargeable to
the operation of the Assured's business, over and above the total cost
that would normally have been incurred to conduct the business during
the same period had no damage or destruction occurred.
Any salvage value of property obtained for temporary use during the
period of restoration which remains after resumption of normal
operations, shall be taken into consideration in the adjustment of any
loss hereunder.
(b) Normal : The term "Normal " wherever used herein shall mean; the
condition that would have existed had no loss occurred.
(c) Month: The word "month" wherever used herein means 30 consecutive
days.
(d) Period of Restoration: The term "period of restoration" means such
length of time commencing with the date of damage and not limited by
the date of expiration of this policy, as would be required with the
exercise of due diligence and dispatch to repair, rebuild or replace
such part of the Assured's property as has been damaged or destroyed.
CONDITIONS
(a) Resumption of Operations: It is a condition of this Insurance that
as soon as practicable, the Assured shall resume normal operations of
the business and shall dispense with such extra expense.
(b) Interruption by Civil Authority: Liability hereunder is extended to
include actual loss as covered hereunder, sustained during the period
of time, not exceeding two weeks, when as a direct result of a peril
insured against, access to the premises in which the property described
is located, is prohibited by order of civil authority.
Page 2 of 3
EXCLUSIONS
In addition to the General Exclusions of this Insurance, Underwriters shall
not be liable for Extra Expense resulting from:
(a) The suspension, lapse or cancellation of any lease, license, contract
or order beyond the period of restoration;
(b) Interference at premises by strikers or other persons with rebuilding,
repairing or replacing the property damaged or destroyed or with the
resumption or continuation of business;
(c) Enforcement of any local or state ordinance or law regulating
construction, repair or demolition of buildings or structures;
Further, Underwriters shall not be liable for:
(a) more than the amount set forth in the limits of liability for each
premises;
(b) loss of income;
(c) the cost of repairing or replacing any of the real or personal property
covered hereunder, or the cost of research or other expense necessary
to replace or restore damaged or destroyed books of account, abstracts,
drawings, card index systems or other records (including film, tape,
disc, drum, cell or other magnetic recording or storage media for
electronic data processing) , that have been damaged or destroyed by the
perils insured against, except cost in excess of the normal cost of
such repair, replacement or restoration necessarily incurred for the
purpose of reducing loss under this policy. In no event shall such
excess cost exceed the amount by which the total extra expense loss
otherwise payable under this policy is thereby reduced;
(d) loss resulting from theft of any property which at the time of loss is
not an integral part of a building or structure (except direct loss by
pillage and looting occurring during and at the immediate place of a
riot or civil commotion) , unless loss by a peril not excluded in this
policy ensues from theft or attempted theft, and then the Underwriters
shall be liable for only such ensuing loss;
(e) any other consequential or remote loss.
Subject otherwise to all terms, clauses and conditions as heretofore.
Page 3 of 3
1015/0631W
ENDORSEMENT attaching to and forming part of Policy No. GHV233/186
in the name of Weld County, Colorado
Effective date of this endorsement is January 15, 1986 Endorsement No.2
It is noted and agreed effective inception of coverage under this policy is extended to
include Weld County Housing Authority.
Subject otherwise to all terms, clauses and conditions as heretofore.
ENDORSEMENT attaching to and forming part of Policy No. OHV230/185
in the name of Weld County, Colorado, et al.
iI
Effective date of this endorsement is January 15, 1986 Endorsement No. 1
li
Type/Coverage:
Excess all risks of physical loss or damage, builders risk, auto physical
damage, comprehensive general liability including hosts/liquor liability, auto
liability including uninsured motorists coverage, incidental malpractice,
police professional liability, workers compensation and/or employers liability
and/or occupational disease, employee fidelity including faithful
performance, extra expense, blanket contractual liability, money and
securities, accounts receivable, valuable papers, personal injury
protection/no fault liability, garagekeepers legal liability excluding inverse
condemnation and seepage and pollution absolutely, hospital malpractice,
sexual misconduct, errors and omissions, asbestos absolutely.
Subject otherwise to all terms, clauses and conditions as heretofore.
IMPORTANT NOTICE TO THE ASSURED
SECTION II INSURING AGREEMENTS C. D AND E ARE ON A CLAIMS MADE BASIS
READ THIS POLICY CAREFULLY
COMBINED PROPERTY, CASUALTY AND CRIME INSURANCE
SECTION I PROPERTY INSURANCE
Agreement A Building and Contents
Agreement B Automobile
SECTION II CASUALTY INSURANCE
Agreement C General Liability
Agreement D Host and/or Liquor Liability
Agreement E Automobile Liability
Agreement F Workers' Compensation and/or Employer's Liability
and/or Occupational Disease
SECTION III CRIME COVERAGE
Agreement G Money and Securities (within premises)
Agreement H Money and Securities (outside premises)
Agreement I Commercial Blanket Bond
DECLARATIONS
ASSURED Weld County, Colorado, including any officers, servant
or employee of the named insured, any member of the
governing board of the named insured, any member of
the Board of Commissioners of Named Insured.
ADDRESS 915 10th Street, Greeley, CO 80631
LIMITS OF LIABILITY See Part I for Excess Loss Fund Protection Agreement.
See Part II for Specific Excess Agreement.
PREMIUM Premium for period see Schedule attached.
TERM OF INSURANCE Effective from 15th January, 1986 to 1st July, 1986
BOTH DAYS at 12.01 A.M. Standard Time at Assured's
address shown above.
RETROACTIVE DATE
(Applicable to
SECTION II Agreements
C, D and E) 15th January, 1986
Page 1 of 22
PART I (EXCESS LOSS FUND PROTECTION AGREEMENT)
LIMITS OF LIABILITY: The Underwriters' Limits of Liability under this
Agreement shall be only for the Excess of Loss over a loss fund of $194,650
ultimate net loss (hereinafter referred to as Assured's Loss Fund) .
As respects any one loss and/or accident or disease and/or claim(s) including
suit(s) brought in connection therewith the Assured's Loss Fund shall not be
charged with
1) any amount in excess of $100,000 Ultimate Net Loss as respects any one
loss and/or accident or disease and/or claim(s) including suit(s) brought
in connection therewith under Sections I, II or III or any combination
thereof, or
2) the first $100 of any loss arising under Section I (except Automobile
Collision Perils) and Section III.
And then in excess of the above amounts up to $183,200 Ultimate Net Loss in
the aggregate in any one period of insurance in respect of the Assured's Loss
Fund.
LOSS FUND ADJUSTMENT: The amount of the Assured's Loss Fund applies to the
first period of insurance of this policy and is subject to review and change
for each period of insurance thereafter.
PART II (SPECIFIC EXCESS AGREEMENT)
LIMITS OF LIABILITY: The Underwriters' Limits of Liability under this
Agreement shall be only for the excess of loss over $100,000 ultimate net loss
each and every loss and/or accident or disease and/or claim(s) including
suit(s) brought in connection therewith up to a further $400,000 ultimate net
loss each and every loss and/or accident or disease and/or claim(s) including
suit(s) brought in connection therewith, under Section I, II or III or any
combination thereof.
GENERAL INSURANCE AGREEMENTS
I . PERIOD OF INSURANCE
The words period of insurance shall be understood to mean the following
period:
Period I - 15th January, 1986 to 1st July, 1986
it,At Page 2 of 22
II NAME OF ASSURED
It is agreed that the unqualified word 'Assured' wherever used in this
Insurance includes not only the Named Assured but also -
1. any official , trustee or employee of the Named Assured while acting
within the scope of their duties as such, and any person,
organization, trustee or estate to whom the Named Assured is
obligated by virtue of written contract or agreement to provide
insurance such as is offered by this Insurance, but only in respect
to operations by or on behalf of the Named Assured;
2. under Section II Agreement E, any person while using an owned
automobile or a hired automobile and any person or organization
legally responsible for the use thereof, provided the actual use of
the automobile is by the Named Assured or with his permission, and
any official of the Named Assured with respect to the use of
non-owned automobile in the business of the Named Assured. This
Insurance with respect to any person or organization other than the
Named Assured does not apply;
(a) to any person or organization, or to any agent or employee
thereof, operating an automobile sales agency, repair shop,
service station, storage garage or public parking place, with
respect to any accident arising out of the operation thereof;
(b) to any employee with respect to injury to or sickness, disease
or death of another employee of the same employer injured in the
course of such employment in an accident arising out of the
maintenance or use of the automobile in the business of such
employer;
(c) with respect to any hired automobile, to the owner or a lessee
thereof, other than the Named Assured, nor to any agent or
employee of such owner or lessee;
(d) with respect to any non-owned automobile, to any official or
employee if such automobile is owned by him or a member of the
same household.
The inclusion hereunder of more than one Assured shall not operate to increase
Underwriters Limits of Liability.
III . TERRITORY
This Insurance applies Worldwide.
Page 3 of 22
IV. In calculating the amount of Ultimate Net Loss under Part I (Excess Loss
Fund Protection Agreement) and Part II (Specific Excess Agreement) , this
Insurance is deemed to include the following maximum limits which will
apply for all purposes to the Assured's Loss Fund and to the Specific
Excess Agreement.
(a) $500,000 in the aggregate annually as respects any Flood loss
under Section I .
(b) $500,000 in the aggregate annually as respects any Earthquake
loss under Section I.
(c) $500,000 any one claim Extra Expense as defined in Endorsement
No. 3 attached hereto.
(d) $250,000 any one claim including suit brought in connection
therewith, Combined Single Limit, Public
Liability/Property Damage under Section II Agreements
C, D and E.
(e) $200,000 any one occurrence or disease under Section II ,
Agreement F, Workers' Compensation and/or Employer's
Liability and/or Occupational Disease.
(f) $100,000 each and every loss under Section III Agreement G.
(g) $100,000 each and every loss under Section III Agreement H.
(h) $100,000 any one claim under Section III Agreement I .
In the event of the exhaustion of any above mentioned aggregate limit(s) ,
the Assured will be liable for their applicable limit of liability
detailed in PART I (EXCESS LOSS FUND PROTECTION AGREEMENT) and PART II
(SPECIFIC EXCESS AGREEMENT) for any further loss and/or claim(s) including
suit(s) brought in connection therewith covered by this Insurance.
Page 4 of 22
F �
412
V. SERVICE ORGANIZATION
This Insurance is issued to the Assured on the express condition that the
Assured undertakes to utilize at all times the services of Gallagher
Bassett Services Inc. This Service Organization shall perform the
following duties:
(a) Administer claims in accordance with accepted industry standards once
notice of a loss has been made to Gallagher Bassett Services Inc.
Perform the notice and reporting requirements to the Underwriters
under the terms of this Agreement.
(b) Maintain accurate records of all reported claims and details incident
to loss and expense payments.
(c) Furnish loss prevention and consulting services. Recommend and
implement controls and monitor loss prevention programs.
(d) Furnish monthly claims records on an approved form.
The acceptance of these services shall be a condition precedent to any
liability which may attach to the Underwriters in accordance with the
terms and conditions of this Insurance.
SECTION I - PROPERTY INSURANCE
INSURING AGREEMENTS
AGREEMENT A - BUILDING AND CONTENTS: Underwriters agree, subject to the
limitations, terms and conditions of this Insurance, to indemnify the Assured
for all risks of physical loss or damage to All Real or Personal Property of
every kind and description wherever located occurring during the period of
this Insurance.
AGREEMENT B - AUTOMOBILE: Underwriters agree, subject to the limitations,
terms and conditions of this Insurance, to indemnify the Assured for loss or
damage to Automobiles owned by the Assured or on which the Assured has an
obligation to provide adequate insurance, wherever located, against All Risks
of Direct Physical Loss, including Collision of the Automobile with another
object.
Page 5 of 22
SECTION 1 - DEFINITIONS
1 . PROPERTY OF THE ASSURED: The term 'Assured's Property' shall mean
All Real and Personal Property, including leasehold improvements or
betterments which the Assured owns, property which the Assured holds
on consignments or agrees to insure by any contractual agreement
normal to its operations.
2. AUTOMOBILE: The term Automobile, shall mean any motor vehicle,
trailer or semi-trailer, including its equipment and any other
equipment permanently attached thereto. The word 'Trailer' shall
include semi-trailer.
3. ULTIMATE NET LOSS: The words Ultimate Net Loss in respect of this
Section shall be understood to mean the loss sustained by the Assured
after making deductions for all recoveries and salvages.
4. EARTHQUAKE: If more than one earthquake shock shall occur within
any period of seventy-two (72) hours during the term of this
Insurance, such earthquake shock shall be deemed to be a single
earthquake within the meaning hereof.
SECTION 1 EXCLUSIONS
WITH REGARD TO ALL PROPERTY, THIS INSURANCE DOES NOT INSURE AGAINST:
1. Loss by moth, vermin, termites or other insects; wear, tear or
gradual deterioration, rust, wet or dry rot or mould.
2. Loss or damage caused by:
(a) Radioactive or fissionable material .
(b) Contamination, other than by (a) above, unless directly
resulting from Fire or Extended Coverage perils.
3. Loss resulting from loss of use (except such loss of use coverage as is
afforded under a Standard Automobile Policy in respect of Agreement B
above) , delay or loss of markets.
4. Breakdown of machinery and/or boiler explosion, but not excluding
loss resulting therefrom.
5. Loss resulting from dampness of atmosphere or variation in
temperature unless caused by the perils of Fire and Extended
Coverage.
6. Loss of electrical appliances or devices of any kind, including
wiring, arising from electrical injury or disturbance to the said
electrical appliances or devices or wiring from artificial causes
unless fire or explosion ensues, and then only for direct loss or
damage caused by such ensuing fire or explosion.
Page 6 of 22
WITH REGARD TO ALL REAL PROPERTY, THIS INSURANCE DOES NOT INSURE AGAINST:
Loss by normal settling, normal shrinkage or normal expansion in
foundations, walls, floors or ceilings.
WITH REGARD TO PERSONAL PROPERTY, THIS INSURANCE DOES NOT INSURE AGAINST:
1. Loss by mechanical derangement, inherent vice or latent defect.
2. Loss resulting from processing or faulty workmanship, unless fire
and/or explosion ensues, and then only for direct loss or damage
caused by such ensuing fire or explosion.
3. Loss resulting from shrinkage, evaporation, loss of weight or
leakage, unless such loss is caused directly by fire or the combating
thereof, lightning, windstorm, hail , explosion, strike, riot or civil
commotion, aircraft, vehicles, breakage of pipes or apparatus,
sprinkler leakage, vandalism and malicious mischief, theft or
attempted theft.
4. Inventory shortage, mysterious disappearances or loss resulting from
any kind of infidelity or dishonesty on the part of the Assured or
any of his employees, except from the perils covered in Section III
(Money and Securities - Broad Form) of this Insurance.
PROPERTY EXCLUDED FROM COVERAGE HEREUNDER:
Animals, aircraft, standing timber, growing crops, accounts, bills,
currency, money, notes, securities, deeds, evidences of debt and
valuable papers.
SECTION I - CONDITIONS
1 . VALUATION: The Underwriters shall not be liable for loss or damage in
excess of:
A. (Real and Personal Property - other than automobile) - the cost to
repair, rebuild or replace the destroyed or damaged property in a
condition equal to but not superior to or more extensive than its
condition when new. If the Assured decides to replace destroyed or
damaged property on another site, cost of such site is not included
hereunder.
It is not a requirement hereunder that the Assured repair, rebuild or
replace the destroyed or damaged property in order to collect for
loss or damage covered by this Insurance.
B. (Automobile) - the actual cash value of the automobile at the time of
loss.
Page 7 of 22
2. DEBRIS REMOVAL: This Insurance covers the expense of removal from the
premises containing the property insured hereunder of debris remaining
after any loss hereby insured against, except that there shall be no
liability assumed for the expense of removal of any foundations.
3. REMOVAL CLAUSE: This Insurance covers the expense and damage occasioned
by removal from the premises endangered by the perils insured against
wherever such property is located or removed for preservation.
4. ARCHITECTS' FEES: This Insurance covers the additional assessment
involving architects, fees for consultations arising from losses resulting
from an insured peril . Fees are limited to seven percent (7%) of
replacement cost.
5. APPRAISAL: In the event the Assured and Underwriters are unable to
agree as to the amount necessary to rebuild, repair or replace the damaged
or destroyed property or the actual amount of reimbursement to be paid,
each party shall name a competent and disinterested appraiser and the two
so chosen shall , before proceeding further, appoint a competent and
disinterested umpire. The appraisers together shall obtain reconstruction
estimates and calculate the amounts of reimbursement due, and failing to
agree shall submit their differences to the umpire.
The award in writing, duly verified by any two, shall determine the points
in question. Both parties shall pay the cost of their own appraisers and
equally pro rate the cost of the umpire.
6. CIVIL AUTHORITY CLAUSE: Notwithstanding anything contained in this
Insurance, property which is insured under this Insurance is also covered
against the risk of damage or destruction by civil authority during a
conflagration and for the purpose of retarding the same; provided that
neither such conflagration nor such damage or destruction is caused or
contributed to by war, invasion, revolution, rebellion, insurrection or
other hostilities or warlike operations.
7. ORDINANCE DEFICIENCY CLAUSE: Notwithstanding anything contained herein
to the contrary, the Underwriters shall be liable also for the loss
occasioned by the enforcement, of any state or municipal law, ordinance or
code, which necessitates, in repairing or rebuilding, replacement of
material to meet such requirements. If demolition is required to comply
with such enforcement Underwriters shall also be liable for such
additional costs.
8. EXPENSE TO REDUCE OR PREVENT LOSS: This Insurance also covers such
expenses as are necessarily incurred for the purpose of reducing or
preventing any loss under this Insurance not exceeding, however, the
amount by which the loss under this Insurance is thereby reduced.
Page 8 of 22
SECTION II - CASUALTY INSURANCE
INSURING AGREEMENTS
AGREEMENT C - GENERAL LIABILITY: Underwriters hereby agree subject to the
Definitions, Exclusions and Conditions hereunder mentioned, to indemnify the
Assured for Ultimate Net Loss by reason of the liability imposed upon the
Assured by law or assumed by the Named Assured under contract or agreement,
for damages direct or consequential in respect of a Claim or Claims including
suit or suits brought in connection therewith, made against the Assured during
the period of this Insurance and which arise solely by reason of personal
injury(ies) , including death at any time resulting therefrom, suffered or
alleged to have been suffered by any person or persons (excepting employees of
the Assured injured in the course of their employment) and/or damage to or
destruction of property or the loss of use thereof resulting from an Accident
which occurs on or after the retroactive date set out in the Declarations.
AGREEMENT D - HOST AND/OR LIQUOR LIABILITY: In accordance with the
provisions of the above Agreement C, the Underwriters agree that indemnity for
the Assured extends to liability for the sale or distribution of alcoholic
beverages by reason of any local , state or Federal Liquor control laws now in
force and all laws amendatory thereto; and that such extension includes
indemnity for loss of means of support.
AGREEMENT E - AUTOMOBILE LIABILITY: Underwriters hereby agree, subject to
the Definitions, Exclusions and Conditions hereunder mentioned, to indemnify
the Assured for Ultimate Net Loss by reason of the liability imposed upon the
Assured by law or assumed by the Named Assured under contract or agreement,
for damages direct or consequential in respect of a Claim or Claims including
suit or suits brought in connection therewith made against the Assured during
the period of this Insurance solely by reason of personal injury(ies) ,
including death at any time resulting therefrom, suffered or alleged to have
been suffered by any person or persons (excepting employees of the Assured
injured in the course of their employment) and/or damage to or destruction of
property or the loss of use thereof, arising out of the ownership, maintenance
or use of any automobile resulting from an Accident which occurs on or after
the retroactive date set out in the Declarations.
Page 9 of 22
AGREEMENT F - WORKERS' COMPENSATION, EMPLOYERS' LIABILITY AND OCCUPATIONAL
DISEASE -
Coverage A - Workers' Compensation - The Underwriters hereby agree to pay
promptly when due all compensation and other benefits required of the Assured
by the workers' compensation law as a result of injury or death (1) by
accident occurring during the period of this Insurance, or (2) by disease
caused or aggravated by exposure of which the last day of the last exposure,
in the employment of the Assured, to conditions causing the disease, occurs
during the period of this Insurance.
Coverage B - Employers' liability - The Underwriters hereby agree to pay on
behalf of the Assured all sums which the Assured shall become legally
obligated to pay as damages because of personal injury or death by accident
or disease, including death at any time resulting therefrom,
(a) sustained in the United States of America, its territories or
possessions, or Canada by any employee of the Assured arising out of
and in the course of his/her employment by the Assured, or
(b) sustained while temporarily outside the United States of America.
its territories of possessions, or Canada by any employee of the
Assured who is a citizen of resident of the United States or Canada
arising out of and in the course of his/her employment by the
Assured; but this insurance does not apply to any suit brought in or
any judgement rendered by any court outside the United States of
America, its territories of possessions, or Canada or to an action on
such judgement wherever brought,
as a result of injury or death (1) by accident occurring during the period of
this Insurance, or (2) by disease caused or aggravated by exposure of which
the last day of the last exposure, in the employment of the Assured, to
conditions causing the disease, occurs during the period of this Insurance.
SELF-INSURER'S STATUS The Assured agrees to duly qualify as a self-insurer
by compliance with the provisions of the Workers Compensation and/or
Occupational Disease Law respecting self-insurance in the State of Colorado
and shall continue to maintain said status throughout the period of this
Insurance provided, however, Underwriters shall not be relieved of their
obligations hereunder because of a breach of this condition until (1) the
Assured becomes insured with respect to his Workers' Compensation and/or
Occupational Disease Liability or (2) the expiration of a period of thirty
days after date of the notice served upon the Assured by the Industrial
Commission terminating his status as a self-insurer, whichever occurs first.
If any employee is injured or dies while engaged in the business operations of
the Assured outside the State of Colorado, this Insurance shall apply to the
Assured on account of such injuries or death irrespective of whether such
liability is greater than it would have been had the injuries been sustained
within the State of Colorado.
Page 10 of 22
SECTION II - DEFINITIONS
1. PERSONAL INJURIES - The term 'personal injuries' , wherever used herein,
shall mean:
(a) Bodily Injury, Mental Injury, Mental Anguish, Shock, Sickness Disease,
Disability, False Arrest, False Imprisonment, Wrongful Eviction,
Detention, Malicious Prosecution, Discrimination, Humiliation, Invasion
of Rights of Privacy, Libel , Slander or Defamation of Character; also
Piracy and any Infringement of Copyright or of Property, Erroneous
Service of Civil Papers, Violation of Civil Rights, Assault and Battery,
and Disparagement of Property.
(b) Injury(ies) arising out of the rendering of or failure to render
Professional medical services to any person or persons (other than
employees of the Assured injured during the course of their employment)
by any duly qualified medical practitioner, or nurse or technician
employed by or acting on behalf of the Assured.
2. PROPERTY DAMAGE - The term 'property damage' , wherever used herein, shall
mean damage to or destruction or loss of property, excluding, however, damage
to property owned by the Named Assured, but including damage to property of
others in the care, custody or control of the Named Assured or property which
is purchased by the Named Assured under a contract which provides that the
title remain with the sellers until payments have been completed, the
liability of Underwriters being limited to the amount of payments outstanding.
3. ACCIDENT - The term "Accident" (EXCEPTING AGREEMENT F) , wherever used in
this Policy, shall mean an event which occurs on or after the retroactive date
set out in the Declarations and which results in Personal Injury(ies) and/or
Property Damage; in which case the Personal Injury(ies) and/or Property
Damage, regardless of whether suffered by each individual person or each
individual entity, shall be treated as resulting from one Accident.
4. CLAIM - The term "Claim(s)", wherever used in this Policy, shall mean any
information that may give rise to damages covered by this Policy, including
suit(s) brought in connection therewith, which the Assured becomes aware of
and provides written notice of the same to Gallagher Bassett Services, Inc.
5. ULTIMATE NET LOSS - The term 'ultimate net loss' shall mean the total sum
which the Assured becomes obligated to pay by reason of personal injury or
property damage claims, either through adjudication or compromise, after
making proper deductions for all recoveries and salvages, and shall also
include hospital , medical and funeral , charges and all sums paid as salaries,
wages, compensation, fees, charges and law costs, premiums on attachment or
appeal bonds, interest, expenses for doctors, lawyers, nurses and
investigators and other persons and for litigation, settlement, adjustment and
investigation of claims and suits which are paid as a consequence of any
occurrence covered hereunder, excluding only the salaries of the Named
Assured's permanent employees. Fees, charges and expenses for Gallagher
Bassett Services Inc. are specifically excluded and are to be paid by the
Assured.
Page 11 of 22
6. (a) WORKERS' COMPENSATION LAW - Applicable to Insuring Agreement F -
The unqualified term "workers' compensation law" means the workers'
compensation law and any occupational disease law of the state
designated in the 'SELF-INSURER'S STATUS' but does not include those
provisions of any such law which provide non-occupational disability
benefits.
(b) STATE - The word "state" means any State or Territory of the United
States of America and the District of Columbia.
(c) PERSONAL INJURY BY ACCIDENT; PERSONAL INJURY BY DISEASE -
The contraction of disease is not an accident within the meaning of
the word "accident" in the term "personal injury by accident" and
only such disease as results directly from a personal injury by
accident is included within the term "personal injury by accident" .
The term "personal injury by disease" includes only such disease as
is not included within the term "personal injury by accident" .
(d) ASSAULT AND BATTERY - Under Coverage B, assault and battery shall
be deemed an accident unless committed by or at the direction of the
Assured.
SECTION II - EXCLUSIONS
THIS INSURANCE DOES NOT APPLY -
(a) to any Claim or Accident in respect of which the Assured either has given
written notice to the insurers of any other insurance before the
inception date set out in the Declarations or gives written notice of
potential Claims where such notice is treated by any insurers as received
by such insurers before the inception date set out in the Declarations;
(b) to any Claim resulting from an event which occurred prior to the
retroactive date set out in the Declarations and which results in
Personal Injury(ies) and/or Property Damage;
(c) to liability of any Assured for assault and battery committed by or at
the direction of such Assured except (i) liability for Personal Injury or
Death resulting from any act alleged to be assault and battery for the
purpose of preventing injury to persons or damage to property and (ii)
liability arising out of corporal punishment;
(d) except with respect to operations performed by independent contractors,
to the ownership maintenance or use, including loading or unloading of
aircraft and watercraft over 25 feet in length;
(e) to damage or destruction of property owned by the Assured;
Page 12 of 22
(f) Applicable to Insuring Agreement F -
(i ) under Coverage B, to liability assumed by the Assured under any
contract or agreement, but this exclusion does not apply to a warranty
that work performed by or on behalf of the Assured will be done in a
workmanlike manner;
(ii ) under Coverage B, with respect to any employee employed in
violation of law with the knowledge or acquiescence of the Assured or any
executive officer thereof;
(iii) under Coverage B, to personal injury by disease unless prior to
thirty-six months after the end of the policy period written claim is
made or suit is brought against the Assured for damages because of such
injury or death resulting therefrom;
(iv) under Coverage B, to any obligation for which the Assured or any
carrier as his insurer may be held liable under the workers' compensation
or occupational disease law of the state designated in the
'SELF-INSURER'S STATUS' , any other workers' compensation or liability
benefits law, or under any similar law.
SECTION II - CONDITIONS
1 . CROSS LIABILITY: In the event of claims being made by reason of
personal injuries and/or property damage suffered by any employee of one
Assured herein for which another Assured herein is or may be liable, then
this Insurance shall cover such Assured against whom a claim is made or
may be made in the same manner as if separate Policies had been issued to
each Assured herein. Nothing contained herein shall operate to increase
the Underwriters' Limit of Liability as set forth herein. The
Underwriters agree to waive all rights of subrogation against all or any
of the corporations of individuals comprising the Assured.
2. NOTICE OF CLAIM: Notice must be given to Gallagher Bassett Services,
Inc. as soon as practicable whenever the Assured has information from
which the Assured should reasonably conclude that a Claim, covered under
Section II of this Insurance, involves injuries or damages.
3. NOTICE OF POTENTIAL CLAIMS: If Gallagher Bassett Services, Inc.
receive notification during any PERIOD OF INSURANCE set out in GENERAL
INSURANCE AGREEMENT I and up to 60 (sixty) days thereafter, of an
Accident which occurs prior to the expiration of any PERIOD OF INSURANCE
set out in GENERAL INSURANCE AGREEMENT I, then Underwriters will treat
any Claim made against the Assured as made on the date on which the
notification was received by Gallagher Bassett Services, Inc. or the
expiry date of any PERIOD OF INSURANCE, whichever is the earlier.
Page 13 of 22
NOTWITHSTANDING the aforementioned or anything else contained herein to
the contrary, any notification received by Gallagher Bassett Services,
Inc. IN EXCESS OF 60 (sixty) days after any PERIOD OF INSURANCE set out
in GENERAL INSURANCE AGREEMENT I of a combined loss involving any
coverages in SECTION I, II or III will render the Assured liable for
their applicable limit of liability detailed in PART II (SPECIFIC EXCESS
AGREEMENT) separately for each coverage arising from said combined loss.
Similarly, in the event of the foregoing the Assured will also be liable
for their applicable limit of liability detailed in PART I (EXCESS LOSS
FUND PROTECTION AGREEMENT) for each applicable PERIOD OF INSURANCE set
out in GENERAL INSURANCE AGREEMENT I.
4. TERMS OF POLICY CONFORMED TO STATUTE: Applicable to Insuring Agreement
F - Under Coverage A the terms of this Policy which are in conflict with
the provisions of the workers' compensation law are hereby amended to
confirm to such law.
5. COMMUTATION: Applicable to Insuring Agreement F - Claims hereunder,
not finally settled, for weekly or periodical payment for compensation
to employees (or their dependents) as a result of death or injury shall
be notified with full particulars by the Assured to the Underwriters
within two years from the expiration date of this Insurance and the
Underwriters may, if they so elect, then or at any time thereafter submit
one or more of such claims to an Actuary or
Appraiser, to be mutually appointed by the Assured and the Underwriters,
and the Underwriters shall at their option pay a lump sum to be fixed by
the Actuary or Appraiser which payment shall constitute a full and final
release of the Underwriters liability for such claim or claims, provided
however that such lump sum payment shall not constitute a full and final
release of Underwriters liability if subsequent to such lump sum payment
any supplemental award is made increasing the amount of compensation
benefits payable to the employee or his/her dependents and that any
additional claim may then be recommuted at Underwriters option and
Underwriters may discharge any additional liability by another lump sum
payment.
SECTION III - CRIME INSURANCE
INSURING AGREEMENTS
AGREEMENT G - MONEY AND SECURITIES (COVERAGE WITHIN PREMISES):
Underwriters agree, subject to the limitations, terms and conditions of this
Insurance, to indemnify the Assured for all loss caused by reason of theft,
burglary, robbery, kidnapping, disappearance or destruction of any money or
securities which may at any time be or believed by the Assured to be in or
upon any premises occupied or used by the Assured or by any bank, trust
company or safe deposit company. Such Insurance as is afforded by this
Insurance also applies to deposits within a night depository safe provided by
a bank or trust company on its premises for the use of its customers.
Page 14 of 22
AGREEMENT H - MONEY AND SECURITIES (COVERAGE OUTSIDE PREMISES):
Underwriters agree, subject to the limitations, terms and conditions of this
Insurance, to indemnify the Assured for all loss caused by reason of the
theft, robbery, kidnapping, disappearance or destruction of any money or
securities (other than by fraud or connivance of the Assured's officers or
employees) while in transit in the custody of the Assured's officers or
employees anywhere, the liability of Underwriters to commence at the moment
when the person into whose hands the property may be delivered on behalf of
the Assured receives the same and to continue until delivery thereof at the
final destination.
AGREEMENT I - COMMERCIAL BLANKET BOND:
Underwriters (hereinafter called 'the Surety') agree, subject to the terms and
conditions set forth herein, to indemnify the Assured (hereinafter called 'the
Employer') against any loss of Money or other property real or personal
(including that part of any inventory shortage which the Employer shall
conclusively prove is caused by the dishonesty of any Employee or Employees)
belonging to the Employer or in which the Employer has a pecuniary interest or
for which the Employer is legally liable or held by the Employer in any
capacity, whether the Employer is legally liable therefor or not, which the
Employer shall during the term of this Insurance sustain or discover that they
have sustained through larceny, theft, embezlement, forgery, misappropriation,
wrongful abstraction, willful misapplication or other fraudulent or dishonest
act or acts committed by any one or more of the Employees as defined, acting
alone or in collusion with others.
SECTION III - DEFINITIONS
INSURING AGREEMENTS G AND H
1 . MONEY: The term 'Money' as used in this Insurance shall be deemed to
mean currency, coin, bank notes, uncancelled and precancelled postage and
unused postage in postage meters.
2. SECURITIES: The term 'Securities' shall be deemed to mean Federal Food
Stamps, express, postal and bank money orders, postal notes, debentures,
scrip, checks, warrants, transfers, coupons, demand and time drafts,
bills of exchange, acceptances, promissory notes, certificates of
deposits, certificates of stock, car trust certificates, interim receipts
and certificates, warehouse receipts, bills of lading and all other
instruments of a similar nature including mortgages upon real estate or
upon chattels and upon interests therein, and assignments of such
mortgages and instruments.
3. It is understood and agreed that this Insurance covers money and
securities of the Assured or as respects which the Assured is legally
liable or held by it in any capacity, whether or not the Assured is
liable for the loss thereof. If legal proceedings are taken against the
Assured to enforce a claim for money and securities so held, the Assured
shall immediately notify the Underwriters in writing.
Page 15 of 22
4. EMPLOYEES: The term 'Employees' shall mean not only persons
compensated by the Assured but also those directed by the Assured, and
including those independent contractors and/or services which may be
considered as usually performed by employees of the Assured.
5. THEFT: The term 'Theft' shall include 'trick and device' .
6. ULTIMATE NET LOSS: The words 'ultimate net loss' in respect of this
Section shall be understood to mean the actual loss sustained by the
Assured after making deductions for all recoveries and salvages.
INSURING AGREEMENT I
1 . EMPLOYER: The term 'Employer' as used in this Section shall mean the
Assured named in the Declarations and as further defined in General
Insurance Agreement II.
2. EMPLOYEE OR EMPLOYEES: The terms 'Employee' or 'Employees' as used in
this Section shall be deemed to mean respectively one or more of the
natural persons who on the effective date of this Insurance or at any
other time during the term of this Insurance are in the regular service
of the Employer in the ordinary course of the Employer's business and who
are compensated by salary, wages and/or commission, and whom the Employer
has the right to govern and direct at all times in the performance of
such service, but not to mean brokers, factors, commission merchants,
consignees, contractors or other agents or representatives of the same
general character.
SECTION III - EXCLUSIONS
THIS INSURANCE DOES NOT APPLY UNDER INSURING AGREEMENTS G AND H
(a) to any fraudulent, dishonest or criminal act other than robbery or safe
burglary or attempted thereat, committed by the Assured or by any
officer, employee (except Brinks or Armored Car Employees) : trustee or
authorized representative of the Assured, whether acting alone or in
collusion with others;
(b) to forgery by whomsoever committed.
Page 16 of 22
SECTION III - CONDITIONS
1. Under INSURING AGREEMENTS G, H AND I
Warranted free of all claims for losses not discovered within the term of
this Insurance and for losses sustained and/or acts committed prior to
15th January, 1986 (hereinafter called the 'Retroactive Date') but with
the understanding that in the event of (a) the expiration of this
Insurance by reason of non-renewal , or (b) the termination of this
Insurance as an entirety, as provided in General Condition 6, the Assured
shall have twelve calendar months following the date of such expiration
or termination in which to discover losses sustained between the
Retroactive Date and the date of such expiration or termination.
Notwithstanding anything to the contrary contained herein it is
understood and agreed that in the event of this Insurance being
immediately succeeded by a similar Insurance with Underwriters on which
the Retroactive Date is 15th January, 1986 the said succeeding insurance
shall be deemed to be a renewal hereof and in consequence the discovery
period provided herein shall not be operative.
2. Under INSURING AGREEMENT I
(a) Upon the discovery of any loss hereunder this Insuring Agreement
shall be treated as reinstated so as at all times to continue in
force for the sum set forth herein notwithstanding any previous loss
for which the Surety may have paid or be liable to pay hereunder
provided however that in no event shall the Surety be liable under
this Insurance for an amount greater than the limits of liability
stated on account of any one loss or series of losses caused by the
fraudulent or dishonest acts of any Employee or in which such
Employee is concerned or implicated.
(b) In case any reimbursement be obtained or recovery be made by the
Employer or by the Surety on account of any loss covered under this
Insurance, the net amount of such reimbursement or recovery, after
deducting the actual cost of obtaining or making the same, shall be
applied to reimburse the Employer in full for that part if any, of
such loss in excess of this Insurance, and the balance if any, or the
entire net reimbursement or recovery if there be no such excess loss,
shall be applied to that part of such loss covered by this Insurance
or, if payment shall have been made by the Surety. to its
reimbursement therefore. The Employer shall execute all necessary
papers and render all assistance not pecuniary to secure unto the
Surety the rights provided for in this paragraph. The following
shall not be reimbursement or recovery within the meaning of this
paragraph: suretyship, insurance or reinsurance; also security or
indemnity taken from any source by or for the benefit of the Surety.
Page 17 of 22
(c) This Insurance shall be deemed cancelled as to any Employee
immediately upon discovery by the Employer, of any fraudulent or
dishonest act on the part of such Employee; or at 12.01 a.m. Standard
Time as aforesaid upon the effective date specified in a written
notice served upon the Employer or sent by registered mail . Such
date if the notice be served shall be not less than fifteen days
after such service, or if sent by registered mail , not less than
twenty days after the date borne by the sender's registry receipt.
(d) It is agreed that within the term 'Employees' are various public
officials of the Named Assured who by law are required to be
separately bonded. It is further agreed that this Section shall
apply as excess insurance and then only after such legally required
other insurance has been exhausted.
SECTION IV - GENERAL CONDITIONS
1. PREMIUM PROVISION:
See Endorsement No. 2 attached.
2. SALVAGE AND RECOVERY CLAUSE:
All salvages. recoveries and payments recovered or received subsequent to
a loss settlement under this Insurance shall be applied as if recovered
or received prior to the said settlement and all necessary adjustments
shall be made by the parties hereto.
3. INSPECTIONS, AUDIT AND VERIFICATION OF VALUES:
The Underwriters or their duly authorized representatives shall be
permitted at all reasonable times during continuance of this Insurance to
inspect the premises used by the Assured and to examine the Assured's
books or records so far as they relate to coverage afforded by this
Insurance.
4. RECORDS:
It is hereby understood and agreed that the records and books as kept by
the Assured shall be acceptable to Underwriters in determining the amount
of loss or damage covered hereunder.
5. DUE DILIGENCE CLAUSE:
The Assured shall use due diligence and do and concur doing all things
reasonably practicable to avoid or diminish any loss of or damage to the
property herein insured.
Page 18 of 22
6. CANCELLATION:
This Insurance may be cancelled as of any anniversary date by either of
the parties upon written notice to the other party, provided said notice
is issued at least sixty (60) days prior to the said anniversary.
NOTWITHSTANDING the aforementioned to the contrary, in the event of
non-payment of premium by the Assured, Underwriters will give ten (10)
days notice of cancellation in writing to the Assured and all coverage
will terminate ten (10) days after the mailing of such notice.
In the event of cancellation under the aforementioned circumstances the
Assured shall bear the full amount of the Loss Fund as stipulated in PART
I (EXCESS LOSS FUND PROTECTION AGREEMENT) .
If the period of limitation relating to the giving of notice is
prohibited or made void by any law controlling the construction thereof,
such period shall be deemed to be amended so as to be equal to the
minimum period of limitation permitted by such law.
7. EXTENDED CLAIMS MADE PERIOD:
In the event of cancellation mentioned in GENERAL CONDITION 6 or
non-renewal , then the Assured, upon payment of an Additional Premium of
not more than 100% of the total expiring premium and at not more than
100% of the total expiring annual Loss Fund, shall have the right to
extend the period in which a Claim is first made against the Assured
after the expiry date of this Insurance for a period of 24 (twenty-four)
months.
PROVIDED always that such Claim results from an Accident which occurred
between the retroactive date and the date on which the extended claims
made period began. In the event of the Assured invoking the foregoing
Underwriters aggregate limits of liability, if any, as respects General
Liability and Automobile Liability and their limit excess of the
Assured's Loss Fund will be reinstated and will apply in full to claim(s)
first made during the Extended Claims Made period.
8. CURRENCY:
The premium and losses under this Insurance are payable in United States
Currency. Payment of premium shall be made to Arthur J. Gallagher & Co.
9. BANKRUPTCY AND INSOLVENCY:
In the event of the bankruptcy or insolvency of the Assured or any entity
comprising the Assured, the Underwriters shall not be relieved of the
payment of any claims hereunder because of such bankruptcy or insolvency.
Page 19 of 22
10. OTHER INSURANCE:
If the Assured has other Insurance against loss covered by this Insurance
the Underwriters shall be liable, under the terms of this Insurance, only
as excess of coverage provided by such other Insurance, and no monies
payable or collectible from such other Insurance shall accrue in the
aggregate loss fund of this Insurance.
11 . MORTGAGE CLAUSE:
The interest of any mortgagor on property covered hereunder is included
as if a separate endorsement were attached hereto to the extent of the
amount of mortgage as of the date of loss subject to the limits of
liability set forth in this Insurance.
12. CLAIMS: (APPLICABLE TO SECTIONS 1 AND III ONLY)
The Assured shall immediately notify Underwriters through Gallagher
Bassett Services, Inc. of any occurrence, the cost of which is likely to
result in payment by Underwriters under this Insurance. Underwriters
shall have the opportunity to be associated with the Assured in defense
of any claims, suits or proceedings relative to an occurrence wherein the
opinion of the Underwriters, their liability under this Insurance is
likely to be involved, in which case the Assured and Underwriters shall
cooperate to the mutual advantage of both.
13. LOSS PAYMENTS:
When it has been determined that Underwriters are liable under this
Insurance, Underwriters shall thereafter promptly reimburse the Assured
for all payments made in excess of the amounts stated in Part I (EXCESS
LOSS FUND PROTECTION AGREEMENT) and Part II (SPECIFIC EXCESS AGREEMENT)
of the Limits Agreement. All adjusted claims shall be paid or made good
to the Assured within thirty days after the presentation to Arthur J.
Gallagher & Co. , and acceptance by Underwriters of satisfactory proof of
interest and loss.
14. APPEAL:
In the event the Assured and Underwriters are unable to agree to the
advisability of appealing a judgment, a disinterested attorney, mutually
agreeable to the Underwriters and the Assured, shall be retained and
directed to render a written opinion as to his recommendation concerning
such appeal . Such written recommendation shall be binding on both the
Assured and Underwriters.
Fees of such retained attorney shall be borne equally by both parties for
the services of rendering his recommendation only. The Assured's portion
of such fee shall not accrue in the aggregate loss fund.
Page 20 of 22
15. LITIGATION PROCEEDINGS:
No suit to recover on account of loss under this Insurance shall be
brought until ninety days after the proof of loss shall have been
furnished, nor at all unless commenced within twenty-seven months from
the date upon which loss occurred, if such loss is within the knowledge
of the Assured; if not, the twenty-seven months shall begin upon notice
to the Assured of such loss or claim.
16. SUBROGATION:
The Underwriters shall be subrogated to all rights which the Assured may
have against any person or other entity in respect to any claim or
payment made under this Insurance, and the Assured shall execute all
papers required by the Underwriters and shall cooperate with the
Underwriters to secure Underwriter's rights. In case any reimbursment
obtained or recovery made by the Assured or the Underwriters on account
of any loss covered by this Insurance, the net amount of such
reimbursement or recovery, after deducting the actual cost of obtaining
or making the same, shall be first applied in the following order:
(a) Amount of loss which exceeds the applicable limit of liability.
(b) To reduce the Underwriters' loss until the Underwriters are fully
reimbursed.
(c) To reduce the Assured's loss because of the application of the
aggregate loss fund.
17. WAIVER OF SUBROGATION:
This Insurance shall not be invalidated if the Assured by written
agreement has waived or shall waive its right of recovery from any party
for loss or damage covered hereunder; provided, that any such waiver is
made prior to the occurrence of said loss or damage.
18. CONFLICTING STATUTES:
In the event that any provision of this Insurance is unenforceable by the
Assured under the laws of any State or other jurisdiction wherein it is
claimed that the Assured is liable for any injury covered hereby because
of non-compliance with any statute thereof, then this Policy shall be
enforceable for the Assured with the same effect as if it complied with
such statutes.
19. ASSIGNMENT:
Assignment of interest under this Insurance shall not bind the
Underwriters until the Underwriters; consent is endorsed hereon.
Page 21 of 22
20. CHANGES:
By acceptance of this Insurance the Assured agrees that it embodies all
agreements existing between the Assured and Underwriters or any of its
agents relating to this Insurance. None of the provisions, conditions or
other terms of this Insurance shall be waived or altered except by
endorsement; nor shall notice to any agent or knowledge possessed by any
agent or by any other person be held to effect a waiver or change in any
part of this Insurance.
21 . WAR CLAUSE:
Coverage does not apply under this Insurance for loss or damage directly
or indirectly occasioned by, happening through or in consequence of war,
invasion, acts of foreign enemies, any weapon of war employing atomic
fission or radioactive force whether in time of peace or war, hostilities
(whether war be declared or not) , civil war, rebellion, revolution,
insurrection, military or usurped power, confiscation or nationalization
or requisition or destruction of or damage to property by or under the
order of any government or public or local authority unless such acts of
destruction by order of civil authority is at the time of and for the
purpose of preventing spread of fire; or claims or liability arising
directly or indirectly from nuclear fission, nuclear fusion or
radioactive contamination.
22. FRAUDULENT CLAIMS:
If the Assured shall make any claim knowing the same to be false or
fraudulent, as regards amount or otherwise, this Insurance shall become
void and all claim hereunder shall be forfeited.
ATTACHING TO AND FORMING PART OF POLICY NO. GHV 230/186
Page 22 of 22
0631W
ORIGINAL.
PSAC POLICY
IN CONSIDERATION of the Insured named in the Schedule hereto having paid the
premium stated in the said Schedule to the Insurers named herein who have hereunto subscribed
their Names ("the Insurers")
THE INSURERS HEREBY SEVERALLY AGREE each for the proportion set against
its own name to indemnify the Insured or the Insured's Executors and Administrators against loss,
damage or liability to the extent and in the manner set forth herein. Provided that the aggregate
liability of the Insurers shall not exceed the Sum Insured or other limits as are set forth in the
Schedule.
If the Insured shall make any claim knowing the same to be false or fraudulent, as regards
amount or otherwise, this Policy shall become void and all claim hereunder shall be forfeited.
IN WITNESS WHEREOF the Policy Signing Manager of THE POLICY SIGNING
& ACCOUNTING CENTRE LIMITED ("PSAC") has subscribed his name on behalf of each of
the PSAC Companies and (where the Companies Collective Signing Agreement ("CCSA") is
being implemented) on behalf of the Leading CCSA Company which is a PSAC member and
authorised to sign this Policy (either itself or by delegation to PSAC) on behalf of all the other
CCSA Companies.
Signed• " "' Policy Department
Policy Signing Manager Seal
Date as in the Schedule.
PSAC POL. I REVISED 9)78
PSAC Whether
The Insurers Company CCSA Proportion Reference Numbers
Number or not
Sphere Drake Insurance Co. PLC S0289 Yes 10% 86JYXCA0838M VAR21000N
86AYXCA0837M VAR06000N
II
Date 6th January., 1987.
Policy No. .GLi.V..2.30./.1.86
THE SCHEDULE
The Insured WELD COUNTY, COLORADO, including any Officer, Servant or
Employee of the Named Assured, any member of the governing body
of the Named Assured, any member of the Board of Commissions of
the Named Assured,
915 10th Street, Greeley, Colorado 80631 .
Premium US$6, 183 part of US$61 ,830 being pro rata for the period.
Kt4I46d
The Interest Insured All Real and Personal Property of every description including
Casualty and Crime Coverages in respect of all operations of
the various Insured operations and for their agencies as more
fully set forth in the Coinsuring Policy detailed below.
This insurance being for 10% part of 100% covers its pro rata
proportion of the risks and liability more particularly
described in the Coinsuring Policy detailed below, and the
percentages signed hereon are percentages of 100%.
Period of Insurance
From 15th January, 1986 To 1st July, 1986 both days
at 12.01 a.m. Local Standard Time.
and for such further period or periods as may be mutually agreed.
COINSURANCE CLAUSE
It is warranted that this Policy shall run concurrently with and be subject to the same terms,
provisions, and limitations as are contained in Policy No.GHV 230/186
issued by Certain Underwriters at Lloyd's, London covering the identical subject
matter and risk.
No...GUY 230/186
0
PSAC
POLICY
Name WELD COUNTY,rY COLORADO-
Ex`�: Date 1st July, 1986.
I""`'+ The duel 'onion of any such total or partial loss and specified associated costs, if any, for which each
i of Us, the L 'erwriters, is liable shall be ascertained by reference to his share, as shown in the said List
^ E of Underwritu Members of Lloyd's, of the Amount, Percentage or Proportion of the Total Sum Insured
,: hereunder whic,. :n the following Table set opposite the definitive number of the Syndicate of which
e'^' such Underwriter a Member.
P --r-
The following Underwriters accept The following Underwriters accept
liability in respect of business liability in respect of business
classified by the Committee of other than Short Tail Business.
Lloyd' s as Short Tail Business.
FOR LPSO USE ONLY BROKER LPSO NO. & DATE
FOR IPSO USE ONLY BROKER LPSO NO. & DATE
518 63222 271 51 86
1 CPC33R 2702 518 63221 271 5186 2241
2239 AMOUNT.PERCENTAGE SYNDICATE UNDERWRITER'S REF. PAGE
AMOUNT,PERCENTAGE SYNDICATE I UNDERWRITER S RE
F PAGE OR PROPORTION
OR PROPORTION , 1 1
PERCENT
PERCENT 27. 5000 210 HQ080300
27.500C 210 HCC83300 3.0000 212 H0080300
3.0000 212 HC08030I 7. 5700 311 CE215S86ARRR
12.5CCC 122 CE214G36ARRR 5. 0000 153 CE215S8bBR.RR
3 .9000 1031 524X511C1X86 3.9000 1031 927X512CLX86
3.6000 1041 924X51101X86 3. 6000 1041 927X51201X86
3. 0000 15 02220903601 3.0000 15 07820903701
4. 5000 582 25941076000N 4. 5000 582 264410760C:0N
2.0000 109. 1711519 2. 0000 109 1711519
1 .0000 144,' 85AC1650155 1 .0000 144 85468850155
6.0000 7991 4051779 838 6. 0000 799 A010279838
3.0000 665f86X52172 3.0333 665 86X52172
2.0300 5291L 15400200020
2. 0900 529 L2JA00201CC0
0. 3750 620 948074400555 0 . 3750 620 958074400555
0. 1250 987! 948014400555 0. 1250 987 9580744G0555
01 . 1625 546 FJ667X86A73R 1. 1625 546 FJ667X86C13 Q•`
0.3375 ' 10071 FJ667X86B73R FOR LPSO USE ONLY BROKER LPSO NO. & DATE J y� •
µ f OR LPSO USE ONLY BROKER LPSO NO. & DATE I 51 8 632 2 2 2 7I 5� 45 ,
'._ 1 ; 518 63221 271 5186 2242
2240 I AMOUNT.PERCENTAGE SYNDICATE UNDERWRITERS REF PAGE
AMOUNT,PERCENTAGE I SYNDICATE UNDERWRITER'S REF. PAGE OR PROPORTION
OR PROPORTION 2
PERCENT
PERCENT 0.3375 1007 FJ667X86D130
1 .6500 j 205 428201252GAL 1.6500 205 488201252GAL
0. 350C 376 423208758X99 0.3500 376 488208758X99
1. CCCO 494 05421749 1.0000 484 00221749
1 . 0000 1204 0031437H1 1 1.0000 204 3081437111
1 . 2500 947 X261U5F903 1.2500 947 B759USQ079
0. 7500 56 R0004345X 0. 7500 56 X1004345X
10.0000 418 2612764186W2 10.0000 418 26127GAL86W2
THE LIST OF UNDERW [ TING MEMBERS THE LIST OF U 'DER% ITING MEMBERS
CF LLOYDS IS, NUMB RED 1986/ 5 OF LLOYDS IS NUMB PED 1986/ r,
1
j ,/ TOTAL LINE N0.OF Mill FOR LPSO USE ONLY TOTAL LINE NO OF SYN0. FOR LPSO USE ONLY
90. 0000 I 23 USB1 11309 90.0000 24 USB1 11651
The List of Underwriting Members of Lloyd's referred to above shows their respective Syndicates and Shares therein,
and is deemed to be incorporated in and to form part of this Policy. It is available for inspection at the Lloyd's Policy
Signing Office by the Assured or his or their representatives and a true copy of the material parts of it certified by the
General Manager of Lloyd's Policy Signing Office will be furnished to the Assured on application.
Hello