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4643 So. Ulster Street, Suite 280, Denver, Colorado 80237
P.O. Box 24809, Denver, Colorado 80224
_.._ ,rt 303/773-9999
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109
DATE SIGNED
GA-USS-DE RETURN TO ORIGINATOR
ORIGINAL
.I�I MI lin iI�►
Lloyd ' s Policy
y
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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LLOYD'S POLICY SIGNING OFFICE • •
General Manager
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J(A)A v NMA 2214 Form approved by Lloyd',Underwriters Non Marine As«!ab AO1 `Y G
\ Printed by The Carlton Berry Co. Ltd AO ,CY S1G\_
•
SERVICE OF SUIT CLAUSE (U.S.A.)
U.S.A. I my amount claimed to be due
NUCLEAR INCIDENT EXCLUSION CLAUSE—I,IABILI'IY—DIRECT(BROAD)
, will submit to the jurisdiction
(Approved by Lloyd's Underwriters'Non-Marine Association) i Clause constitutes or should
U.S.A. :ion in any Court of competent
ot Court, or to seek a transfer
RADIOACTIVE CONTAMINATION EXCLUSION CLAUSE- 'i7Vy State in the United States.
PIIVQIC A naMArr nrorr-r .�
U•S•A.
RADIOACTIVE CONTAMINATION EXCLUSION CLAUSE—LIABILITY—DIRECT ' and
(Approved by Lloyd's Underwriters'Non-Marine Association) - -writers will abide by the final
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 behalf of Underwriters in any
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 en undertaking to the Insured
nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. Jehalf in the event such a suit
13/2/64
N.M./1/4. 1477
States which makes provision
Inereot,WIT any person or organization. — Toner or Director of Insurance
II. Under em Medical Payments ('overage. or under any Supplementary Payments Provision relating to
immediate medical or surgical relict,to expenses incurred with respect to bodily injury,sickness,disease successors in office, as their
sir death resulting front the hazardous properties of nuclear material and arising OW c 1 the operation of a
nuclear facility by any person or organization. lny action, suit or proceeding
III Under any liability Coverage, to injury, sickness, disease, death or destruction resulting from the
hazardous properties of nuclear material,if — icier arising out of this contract
(a) the nuclear material(1)is at any nuclear facility owned by,or operated by or on behalf of,an
insured or(21 has been discharged or dispersed therefrom; sson to whom the said officer
(hi the nuclearinblerial is contained in spent fuel or waste at any time possessed, handled, used,
processed,,gored,transported or disposed of by or on behalf of an insured;or
le) the injury,sickness,disease,death or destruction arises out of the furnishing by an insured of
services, materials, parts or equipment in connection with the planning, construction,
maintenance,operation or use of any nuclear facility, but it such facility is located within the
United Stales of America,its territories or possessions or Canada,this exclusion(c)applies only [id-
m injury to or destruction of property at such nuclear facility.
IV. As used in this endorsement:
"hazardous properties" include radioactive, loxic or explosive properties; "nuclear material" means
source material, special nuclear material or byproduct material; "source material'', "special nuclear
material",and"byproduct material"have the meanings given them in the Ammic Energy Act 1954 or in
any law amendatory thereof; "spent fuel"means any fuel element or fuel component,solid or liquid,
which has been used or exposed to radiation in a nuclear reactor: "waste"means any waste material(1)
containing byproduct material and(2)resulting from the operation by any person or organization of any
�
nuclear la iliiy included within the definition of nuclear facility under paragraph (a) or(bl thereof; �
"nuclear facility"means
(a) any nuclear reactor,
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ORIGINAL
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PSAC POLICY \\D B
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 11% 85AYXCA0201M
VAR0600N
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•
•
Date....19th..,January,...1987
Policy No. GHV 230/286
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$503.80 part of US$4,580.00 for the period.
StliftItUtt(61
The Interest Insured Legal Liability in respect of the Insured' s operations as more
fully set forth in the Coinsuring Policy referenced below.
This insurance being for 11% part of 100% covers its pro rata
proportion of the risks and liability more particularly
described in the Coinsuring Policy, and the percentages signed
hereon are percentages of 100%.
kouvexkftriix
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 230/286
issued by Certain Underwriters at Lloyd's, London covering the identical subject
matter and risk.
No.GHV..230/286 or
O
Al
g-I
PSAC
POLICY
Name WELD COUNTY, COLORADO
Expiry Date 1st July, 1986.
Schedule
Policy or Certificate No. GHV 230 / 286 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 body of the Named Assured, any
member of the Board of Commissions of the Named Assured,
915 10th Street,
Greeley,
Colorado 80631 .
The risk, interest, location and sum insured hereunder
EXCESS ALL RISKS OF PHYSICAL LOSS OR DAMAGE INSURANCE INCLUDING CASUALTY AND
CRIME.
This insurance being for 89% part of 100% covers its pro rata proportion of
the risks and liability more particularly described in the attached wording,
which is hereby declared to be incorporated in and to form part of this
policy, and the percentages signed hereon are percentages of 100%.
The Premium US$4,076.20 part of US$4,580.00 for the period.
The perio of sofa ce��frrr,oml5thS}h��Ja,{{nuary�s 1986 cast July, 1986
both daysk e{ d tocfsucn nattier Standard periods as may be mutually agreed upon
Dated in '.,� Lo on thel9th January, 1987.
' R Jor 7
J(A) (Schedule) NMA 2215 for attachment to NMA 2213, NMA 2214, NMA 2216 or NMA 2217
DROP DOWN FORM
Whereas the Assured has (1) All Risks of Physical Loss or Damage cover with
International Surplus Lines Insurance Company for $500,000 each claimant in
the aggregate where applicable excess of $500,000 each and every loss and/or
occurrence and (2) Underlying insurances for $400,000 each and every loss
and/or occurrence excess of $100,000 each and every loss and/or occurrence
covering All Risks of Physical Loss or Damage, Casualty, Medical Payments,
Crime, Fidelity and Errors and Omissions (both of which policies warranted
maintained in force throughout the currency of this policy) .
This insurance is to pay up to $650,000 each and every loss and/or occurrence
but only if the same loss and/or occurrence includes a Casualty and/or Medical
Payments and/or Crime and/or Fidelity Loss in addition to a Physical Damage
Loss and then only if this combined loss and/or occurrence exceeds $500,000.
This policy will then pay the difference between the primary $500,000 Ultimate
Net Loss (Physical Damage or combined Physical Damage and Casualty Loss) and
the actual combined loss and/or occurrence (up to a further limit of $650,000
Ultimate Nett Loss but not exceeding the sum of the applicable limits as
detailed below) .
The Underlying Combined Policy contains the following sub limits:
All Third Party: $250,000 any one claim.
Workers' Compensation Act/
Employers' Liability/
Occupational Disease: $200,000 any one occurrence.
Money and Securities: $100,000 each and every loss each location.
Employee Fidelity: $100,000 each and every loss
IT IS UNDERSTOOD AND AGREED that Claims and Servicing will be by Gallagher
Bassett Services Inc.
ULTIMATE NET LOSS
The words "ultimate net loss" in respect of Physical Loss or Damage shall mean
the loss sustained by the Assured as a result of the happening of the risks
covered by this Insurance after making deductions for all recoveries and other
valid and collectible insurance, excepting however, the Policy/ies of the
Primary Insurers, and in respect of Liability Coverage hereon ultimate net
loss shall be as defined in the Primary Policy.
Page 1 of 2
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.
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.
Page 2 of 2
so
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• "AF - The due proportion of any such total or partial loss and specified associated costs, if any, for which each
o0f Us, the Underwriters, is liable shall be ascertained by reference to his .share, as shown in the said List
of Underwriting Members of Lloyd's, of the Amount, Percentage or Proportion of the Total Sum Insured
D
hereunder which is in the following Table set opposite the definitive number of the Syndicate of which
w such Underwriter is a Member.
nFOR LPSO USE ONLY BROKER LPSO NO. & DATE T FOR LPSO USE ONLY BROKER LPSO NO. & DATE
CP)33R 518 632)7 231 51 86 '; 518 63207 231 51 861
2408 2409
AMOUNT,PERCENTAGE SYNDICATE UNDERWRITER'S REF. PAGE AMOUNT,PERCENTAGE SYNDICATE UNDERWRITER'S REF. I PAGE
OR PROPORTION 1 OR PROPORTION
PERCENT PERCENT 2
17. 50 21 ) H)030130 2.00 235 9044131
2.00 212 HOC 80130 2.00 15 02807578
3. 90 1 )31 927X512)5X85 3. 00 529 L2K20019d000
3.63 1041 927X51205X35 2. 50 33 106C326
6.00 47 049827PXX 2.r0 510 X0930018009B
5.30 57 199FXXXXXGAL 1. 50 205 428301746GAL
2.50 26 ) 199FXXXXXGAL 0. 50 376 428310615GAL
5.00 553 CATX830964 0. 75 620 9550740G06G5
4. 30 504 993314305 3.25 987 9550740606G5
4.00 665 85X52098 0. 50 144 85A68F50233
3.00 )47 X76 )USQ235
3.50 484 0C220509 THE LIST OF U DFRWRITING MEMBERS
7.50 92 077P016SUND OF LLOYDS IS NUMBERED 1986/ 5
2.50 109 17L2153
1.00 224 338100071
3.00 56 R3309557X
1 TOTAL LINE NO.OF SYND. ,.--^- R LPSO USE ONLY TOTAL LINE NO.OF SYNC]. FOR LPSO USE ONLY
89.CO c, 0. 26 USB1 10748
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1
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.
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