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THE TRAVELERS MNITY
P�Ider HARTFORD
INDE• CONNECTICUT COMPANY
(A Stock Insurance Company, Herein Called The Travelers) �-
a LI (POLICY TITLE) One
Si.
9 - I r(.," ) 0': ',,�:_. No. ND 6256402 DECLARATIONS
,.L Insurance is afforded only under those sections of this policy as are indicated by entry of "Included" opposite thereto. The insurance q.t....
'01.: afforded under a section is limited to the extent set forth in the declarations,forms and other policy provisions applicable to the section. e,'e
I
6 I Dam 1. Named Insured ! WELD COUNTY -
1I 911. 9TH AVE ,,- it
eiI4 Address GRCELEV , Wit 1 ( ( r1T`il tit :74..- /D."? 64,
(No..street.town,county,state) 1
P,1e Nom 2. Policy effective from I 1/15/68 to ,it., :..., I 12 noon, .,p e
i standard time at the address of the Named Insured as stated herein. F{"
Item 3. Section—Kind of Insurance (Included)
I Fire and Other Related Physical Damage Perils Y.(d Ut) C'1 s
a II General Liability 1 h! _(J;) T'J jt'UJ ,.:1A Symbol numbers o •a
III Automobile Liability
of applicable dec-
PII IV Automobile Physical Damage larations pages e,1
•in V Crime forming a part of y1.§
this policy on its
effective date.
yi^ r
P I I Item 4. Payment of Provisional Premium: E 2O29OO65 Total Provisional Premium owe
3y.:,
6764.65 Due at policy inception 0'4
Z 676_3, OO Due at end of each subsequent ],;-inonth period
r I I The agreements of The Travelers contained in this policy are made with the Insured named above,in consideration of the payment of „,)s
,r, the premium and in reliance upo the statements in the declarations and subject to all the terms of this policy: 74i
l $ 6764.65 °�"
J d0
,(" 9940,00 -r-
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$16704.65 ''
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HOPKINS-LUNDY INSURORS,
2001st Noll Bonk Bldg.,3 -5536 7,v
yr � ..-.// rC5
Countersigned
° '. INSTITUTIsNAL PACKAGE POLICY pie
First Annual Premium 416,704,65 7 6...s;
,
I e �
o 7 re
County General Fund $14,180.65
P,.I Bridge & Road Fund 2,5`24,00 o eR,r
�> den
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Ia]J4 Edition IYtay 1964 PRINTED IN U.S.A. NS page 1 S+u
�,f
5 152
(Attach For'—and Endorsements Herewith all Declaratr', pages on top) Page 2
General Conditions
•
(Unless otherwise indicated, the General Conditions apply to all Sections)
1. Application of Policy—Sections I, II, III and IV of this policy apply • (3) Upon The Travelers' request, the Insured shall submit to
only to accidents,occurrences and loss which occur during the period examination by The Travelers, subscribe the same, under
this policy is in effect within the United States of America, or oath if required, and produce for The Travelers' examina-
Canada. tion all pertinent records, all at such reasonable times and
Section V of this policy applies only to loss which occurs during places as The Travelers shall designate,and shall cooperate
the period this policy is in effect within the.United States of America, with The Travelers in all matters pertaining to loss or
Virgin Islands, Puerto Rico, Canal Zone-or Canada and which is claims with respect thereto.
discovered not later than one year after termination or cancellation 3. Section I—Certain Other Insurance Not Permitted—Other insur-
of Section V, except (1) such period of discovery with respect to ance covering the property insured is not permitted,except against
Coverage N-2 shall be two years,and (2)the territorial restriction losses not insured against under this policy or unless this policy is
does not apply to Coverage N,N-1 or N-2 if the loss is sustained by otherwise endorsed.
the Insured through fraudulent or dishonest acts committed by any 4. Other Insurance
of the employees of the Insured engaged in regular service within (a) Section I—Unless otherwise endorsed,this policy shall be excess
the above designated territory while such employees are elsewhere over any other insurance whether prior or subsequent hereto,
for a limited period. and by whomsoever effected,directly or indirectly covering loss
2. Insured's Duties in the Event of Loss,Accident or Occurrence or damage insured hereunder,and The Travelers shall be liable
(a) Sections I and IV—Upon knowledge of loss which may give only for the excess of such loss or damage beyond the amount
rise to a claim hereunder,the Insured shall: due from such other insurance, whether collectible or not, but
(1) as soon as practicable,give notice thereof to The Travelers, not to exceed the applicable limit of liability.
protect the property from further loss or damage, furnish If other insurance is permitted and loss under this policy is sub-
an inventory of damaged and undamaged property,showing ject to a deductible, The Travelers shall not be liable for more
quantities,costs and actual cash value,and notify the police than its pro rata share of such loss in excess of the deductible
of any claim resulting from burglary, robbery or theft, if amount.
such coverage is provided under this policy; (b) Sections II, III, and IV—If the Insured has other insurance
(2) within 60 days of said loss, file with The Travelers a signed against a loss covered by this policy,The Travelers shall not be
proof of loss, duly sworn to, stating the time and origin of liable under this policy for a greater proportion of such loss than
loss,the interest of the Insured and of all others in the prop- the applicable limit of liability stated in the declarations bears
erty, the actual cash value and amount of claim for each to the total applicable limit of liability of all valid and collectible
item thereof, and the identity of all other insurance on the insurance against such loss, provided the insurance under
property,valid or otherwise; Section III with respect to any temporary substitute automo-
(3) as often as may be reasonably required, exhibit to any bile, any hired automobile insured on a cost of hire basis or
any non-owned automobile and the insurance under division 2
person designated by The Travelers all that remains of any
property herein described, and submit to examinations of Coverage H shall be excess insurance over any other valid and
under oath at demand of The Travelers,and subscribe the collectible insurance.
same,and produce for examination all pertinent records and (c) Section V—If there is available to the Insured any other insur-
documents and cooperate with The Travelers in all matters ance or indemnity covering any loss covered by Section V,The
pertaining to loss or claim. Travelers will be liable hereunder only for that part of such loss
which is in excess of the amount recoverable or recovered from
(b) Sections II and III— such other insurance or indemnity,provided the insurance under
(1) When an occurrence happens written notice shall be given by Coverages O, P and Q shall not apply(1)to property which is
or on behalf of the Insured to The Travelers or any of its separately described and enumerated and specifically insured in
authorized agents as soon as practicable. Such notice shall whole or in part by any other insurance, or (2) to property
contain particulars sufficient to identify the Insured and otherwise insured unless such property is owned by the Insured.
also reasonably obtainable information respecting the time, The Travelers waives any right of contribution which it may
place and circumstances of the occurrence, the names and have against any forgery insurance carried by any depository
addresses of"the injured and of available witnesses. bank which is indemnified under Coverage R.
(2) If claim is made or suit is brought against the Insured, the 5. Subrogation—In the event of any payment under this policy, The
Insured shall immediately forward to The Travelers every Travelers shall be subrogated to all the Insured's rights of recovery
demand,notice,summons,or other process received by him therefor against any person or organization and the Insured shall
or his representative. execute and deliver instruments and papers and do whatever else
(3) Coverages D, F, and G—The Insured shall cooperate with is necessary to secure such rights.The Insured shall do nothing after
The Travelers and, upon The Travelers' request, attend loss to prejudice such rights.
hearings and trials and assist in making settlements, secur- 6. Action Against The Travelers
ing and giving evidence, obtaining the attendance of wit-
ti ot
nesses, and in the conduct of any legal proceedings in (a) any claim shall be sustainable in� policy for recovery
any of law or equity
connection with the subject matter of this insurance. The unless all the requirements of this policy shall have been corn-
Insured shall not,except at his own cost,voluntarily make plied with,and unless commenced within 12 months next after
any payment, assume any obligation or incur any expense inception of the loss;provided, however,that if under the laws
other than for such immediate medical and surgical relief of the State within which this policy is issued such limitation is
to others as shall be imperative at the time of accident. invalid, any such claim shall be void unless such suit or action
(4) Coverages E and H—As soon as practicable the injured be commenced within the shortest limit of time permitted by
person or someone on his behalf shall give to The Travelers the laws of such State.
written proof of claim under oath if required, and shall, (b) Sections II,III, and IV
after each request from The Travelers, execute authoriza- (1) Coverages D, F, and G—No action shall lie against The
tion to enable The Travelers to obtain medical reports and Travelers unless, as a condition precedent thereto, the
copies of records.The injured person shall submit to physical Insured shall have fully complied with all the terms of this
examination by physicians selected by The Travelers when policy, nor until the amount of the Insured's obligation to
and as often as The Travelers may reasonably require. pay shall have been finally determined either by judgment
(c) Section V— against the Insured after actual trial or by written agree-
(1) Upon knowledge or discovery of loss or of an occurrence ment of the Insured, the claimant,and The Travelers.
which may give rise to a claim for loss,the Insured shall(i) Any person or organization or the legal representative
give notice thereof as soon as practicable to The Travelers thereof who has secured such judgment or written agree-
or any of its authorized agents and, under Coverages O, P meet shall thereafter be entitled to recover under this policy
and Q, also to the police if the loss is due to a violation of to the extent of the insurance afforded by this policy.
law,and (ii) file detailed proof of loss, duly sworn to, with Nothing contained in this policy shall give any person or
The Travelers within four months after the discovery of organization any right to join The Travelers as a co-
loss. defendant in any action against the Insured to determine
(2) Proof of loss under Coverage R shall include the instrument the Insured's liability. Bankruptcy or insolvency of the
which is the basis of claim for such loss, or if it shall be Insured or of the Insured's estate shall not relieve The
impossible to file such instrument, the affidavit of the In- Travelers of any of its obligations hereunder.
sured or the Insured's bank of deposit setting forth the (2) Coverages E and H and Section IV—No action shall lie
amount and cause of loss shall be accepted in lieu thereof. against The Travelers unless, as a condition precedent
(Continued on page 3)
Page 3
thereto, there shall have been full compliance with all of 11. Terms of Policy Conformed to Statute—The terms of this policy
the terms of this policy,nor until 30 days after proof of loss which are in conflict with the statutes of the State wherein this policy
is filed and, under Section IV, the amount of loss is de- is issued are hereby amended to conform to such statutes.
termined as provided in this policy.
(c) Section V—No action shall lie against The Travelers unless,as a 12. Continuous Policy—The following provisions shall apply only to
condition precedent thereto, there shall have been full corn- policies written on a continuous basis without a stated expiration
pliance with all the terms of this policy nor until 90 days after date:
the required proofs of loss have been filed with The Travelers, (a) "Policy Period" or "Policy Term" means the period until the
nor at all unless commenced within two years from the date next anniversary of the policy effective date or until cancella-
when the Insured discovers the loss. If any limitation of time tion, whichever first occurs.
for notice of loss or any legal proceeding herein contained is
shorter than that permitted to be fixed by agreement under any (b) Premiums and Rates shown herein are subject to adjustment on
statute controlling the construction of this policy, the shortest each anniversary of the policy effective date in accordance with
permissible statutory limitation of time shall govern and shall the then current rates, rules, and rating plans in use by The
supersede the time limitation herein stated. Travelers for this policy.
7. Liberalization Clause—If during the period that insurance is in (c) Policy Forms, Declarations, Supplemental Contracts, and En-
force under this policy, or within 45 days prior to the inception dorsements contained herein are subject to substitution on
date thereof,on behalf of The Travelers there be filed with and ap- • each anniversary of the policy effective date in accordance with
proved or accepted by the insurance supervisory authorities,in con- the then current forms, declarations, supplemental contracts,
formity with law,any forms, endorsements, rules or regulations by and endorsements in use by The Travelers for this policy._
which this policy could be extended or broadened, without ad-
13. Cancellation—This policy may be canceled by the Named Insured
hn
the
n such extended or broadened insurance shall inure to the the cancellation shall be effective. This policy may be canceled by
benefit of the Insured hereunder as though such endorsement or The Travelers by mailing to the Named Insured at the address
substitution of form had been made. shown in this policy and to any mortgagee(or trustee)designated in
8. Inspection and Audit—The Travelers shall be permitted to inspect this policy written notice stating when not less than ten days there-
the insured premises, operations and automobiles and to examine after such cancellation shall be effective. The mailing of notice as
and audit the Insured's books and records at any time during the aforesaid shall be sufficient proof of notice. The effective date and
policy period and within three years after the final termination of hour of cancellation stated in the notice shall become the end of the
this policy,as far as they relate to the premium bases or the subject policy period. Delivery of such written notice either by the Named
matter of this insurance. Insured or by The Travelers shall be equivalent to mailing.
9. Assignment—Assignment of this policy shall not be valid except If the Named Insured cancels, earned premium shall be computed
with the written consent of The Travelers;if, however,the Named in accordance with the customary short rate table and procedure. If
Insured shall die, this policy shall cover such Insured's legal repre- The Travelers cancels,earned premium shall be computed pro rata.
sentative as Named Insured; provided that notice of cancellation Premium adjustment maybe made either at the time cancellation is
addressed to the insured named in the declarations and mailed to effected or as soon as practicable after cancellation becomes effective,
the address shown in this policy shall be sufficient notice to effect but payment or tender of unearned premium is not a condition of
cancellation of this policy. cancellation.
10. Changes—Notice to any agent or knowledge possessed by any If the premium for this policy is made payable in instalments in
agent or by any other person shall not effect a waiver or a change in consideration of an increase in premium, and the Insured is in de-
any part of this policy or estop The Travelers from asserting any fault of any payment,the amount of premium previously paid shall
right under the terms of this policy;nor shall the terms of this policy be regarded as having been earned by The Travelers,and this policy
be waived or changed,except by endorsement issued to form a part may then be canceled in accordance with its terms; but this clause
of this policy, signed by the President, a Vice President,Secretary does not apply to the portion of a policy premium subject to a report-
or Assistant Secretary of The Travelers;provided,however,changes ing clause or subject to adjustment upon audit.
may be made in the written portion of the declarations by a manager
or general agent of The Travelers when initialed by such manager or 14. Concealment or Fraud—This policy shall be void if, whether before
general agent.Whenever an endorsement forming a part of a Section or after a loss,the Insured has wilfully concealed or misrepresented
of this policy refers to"policy"or"supplement",the reference shall any material fact or circumstance concerning this insurance or the
be deemed to mean the Section of this policy of which such endorse- subject thereof, or the interest of the Insured therein,or in case of
ment forms a part. • any fraud or false swearing by the Insured relating thereto.
IN WITNESS WHEREOF,The Travelers Indemnity Company has caused this policy to be signed by its President and Secretary at Hartford, Con-
necticut, and countersigned on page 1 of this policy by a duly authorized agent of The Travelers.
�.7\a Se
cretary
President
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The Travelers Indemnity Company
Hartford, Connecticut
Policy Number NSL 2251201
DECLARATIONS COMPREHENSIVE AUTOMOBILE—GENERAL LIABILITY POLICY
Item T. Named Insured I WELD COUNTY
911 9TH AVENUE
Address GREELEY, WELD CO. , COLORADO
(No.,street,town,county,state)
Rem 2. Policy Period: From JAN . 15, 1968 to JAN. 15 , 1969 12:01 A.M.t
Item 3. Limits of Liability
Coverages each each Advance
Parts person occurrence aggregate Premium
Comprehensive Bodily Injury Liability 300 M 500 M 500 M$ 3920
L 1 General Property Damage Liability 1 00 M 300 M$ 2363
Comprehensive Bodily Injury Liability 300 M 500 M $ 1842
L 2 Automobile Property Damage Liability 1 00 M $ 1 647
Contractual Bodily Injury Liability M M $ The insurance afforded is only with
respect to such of the Coverage
Liability Property Damage Liability M M3 Parts as are indicated by Symbol
Premises $ each person
Medical Payments Number and the Coverages therein
y $ M each accident S
as are indicated by specific premium
Automobile Medical Payments $ each person $
charge. The limit of the company's
Uninsured Motorists $ M each person
liability against each such Coverage
(Damages for Bodily Injury) $ M each accident $
shall be as stated herein, subject to
Comprehensive $ $
all the terms of this policy having
Automobile Collision ACV Less$ Deductible $ reference thereto. In any Limits of
Physical Fire, Lightning or Transportation S
Damage Theft $ $ Liability space the letter "M"
$ means "Thousands of Dollars" and
Combined Additional
the letters "ACV" mean "Actual
Cash Value".
L 22 HOSPITAL PROFESSIONAL $ 168
$
Symbol numbers of Schedules,Endorsements,
and additional Coverage Parts forming a SEE END 9380 $ 9940 ✓
part of this policy on its effective dote.
Total Advance
Premium
Item 4. (a) The named insured is: individual ❑; partnership ❑; corporation ❑; joint venture ❑; other: COUNTY
(b) Audit Period: Annual, unless otherwise stated: semi-annual ❑; quarterly ❑; monthly ❑
Item 5. During the past three years no insurer has canceled insurance,issued to the named insured,similar to that afforded hereunder,unless otherwise stated
herein:
General Liability Coverage Parts—The declarations are completed on an accompanying schedule designated "General Liability Hazards".
Automobile Liability Coverage Parts—The declarations are completed on an accompanying schedule designated "Automobile Liability Hazards".
tStandard time at the address of the named insured as stated herein.
Countersigned b _` -'L c < < -- "'".1-1--------
Keep this declarations page in your "Policy Jacket—Edition July 1, 1960', Form C-11113. These declarations and all Coverage Parts, Schedules and
Endorsements issued to form a part hereof, together with your Policy Jacket,form your complete insurance policy.
C-11115 Edition July 1, 1966 PRINTED IN V.S.A. 1266
SYMBOL NUMBERS OF ENDORSEMENTS
Amending Policy No. NSL 2251201
It is agreed that endorsements with the following symbol numbers form a part of this policy on its effective date:
G210 GA-39 8870(2)
G309 8800 8890(2)
G314 8810(2) 9380
G610 8840 8000(A)
THE TRAVELERS INSURANCE COMPANY THE TRAVEELER/RSSS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY
Secretary Secretary Secretary
C-10925 1-66 PRINTED IN U.S.A. 9380
Effective from JAN. 15, 1968 at the time of day the policy becomes effective. Amending Policy No. NSL 2251201
Issued to WFLI1 COUNTY
Date of Issue: JANUARY 25, 1968 OS
OFfAFlOE f1 ENV OS2 _241 707 ""°°' HOPK I NS L UNDY I NSRS I NC
FOq 4 UE y USE EPI"ES 1/1c/69
AW0Sr." A giSN°F x
(The information provided for above,except the policy number, is required to be stated only when this endorsement is issued for attachment to
the policy subsequent to its effective date.)
It is agreed that as of the effective date hereof the policy is amended in the following particulars:
THE FOLLOWING COUNTY COMMISSIONERS ARE ADDITIONAL INSUREDS, BUT ONLY
WHILE ACTING WITHIN THE SCOPE OF THEIR DUTIES AS SUCH :
EDWARD L . DUNBAR
MARSHALL H . ANDERSON
HAROLD W. ANDERSON
8000(A)
This endorsement is executed on the reverse side hereof. SYMBOL No.
TAE TRAVELERS INSURANCE COMPANY
THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAS FIRE INSURANCE COMPANY
Secretary
Secretary \ f � 7
C-10747 (Small) 2-65 PRINTED IN U.S.A. - Secretary
Countersigned .::::"- c.,... ✓—._. 2-i
f .
•
DECLARATIONS SCHEDULE—General Liability Hazards No. 1 Policy No. NSI 2251 201
The letters "MP" wherever used in this schedule shall mean "Premium for Premises Medical Coverage". Inclusion of a premium for Premises
Medical Payments Coverage immediately below the Bodily Injury Liability premium for any elevator shall mean that Premises Medical Payments
Coverage is afforded with respect to such elevator. In the Rates and Advance Premium columns"BI" means "Bodily Injury Liability"and "PD"
means "Property Damage Liability".
Location of all premises owned by, rented to or controlled by the named insured (Enter "same" if same location as address shown in Item 1.of
declarations): SEE BELOW
Interest of named insured in such premises(Describe interest, such as "owner", "general lessee" or"tenant"): UNKNOWN
Part occupied by named insured: UNKNOWN
Comprehensive General Liability Insurance. The following discloses all hazards insured hereunder known to exist at the effective date of this policy,
unless otherwise stated herein:
Description of Hazards Code No. Premium Bases" Rates Advance Premium
_ BI I PD BI I PD
A—Premises—Operations I A—Area(Sp.Ft.) A—Per too S9.Ft.of Area
B—Elevators B—Frontage B—Per Linear Foot
C—Independent Contractors C—Remuneration C—Per $100 of Remuner-
D—Completed Operations D—No. Insured ation
E—Products E—Cost 1:—PerElevator
F—Receipts E—Per$100 of Cost
G—Sales F—Per$1000 of Receipts
II—Admissions G—Per$1000 of Sales
H—Per 100 Admissions
AS PER SCHEDULE 8810 3920 2363
Minimum Premiums Premises—Operations Independent Contractors Products
BI PD BI PD BI PD
C-It166 7-66 PRINTED IN O.S.A. (Use with Coy.Parts L1,9,10,
11,13,54,25) 467 *See over for Description of Premium Bases 8800
DECLARATIONS SCHEDULE—General Liability Hazards No. ? Policy No. NSL 2251 201
Description of Hazards Code No. , Premium Bases Rates Advance Premium
BI PD BI PD
A-BUILDINGS OR PREMISES OFFICE 0122
HOMES FOR THE AGED
( SUBJ TO END G314 & G610) 0147S
FAIR GROUNDS-NON-OPERATION
SEASON
(SUBJ TO END G309) 0301B
EXHIBITION BUILDINGS 0191S* A-13 ,500 .296 '.0049 40 1
PRIVATE RESIDENCES N .O . C . EACH
INITIAL RESIDENCE 0338* 1 3 .42 1 .154 3 1
ADDITIONAL RESIDENCE EACH
(SUBJ TO END G210) 0770* 3 2 . 05 ' .304 2 1
LIBRARIES OR MUSEUMS 0132* 9, 600 .15 .0036 14 1
HIGHWAYS OR ROADS, STATE ,
COUNTY, OR TOWNSHIP- INCLUDING
CUUBERTS AND BRIDGES
EXCEPT TOLL BRIDGES AND
DRAWBRIDGES MILES
(SUBJ TO END G610) 0378* 5 ,000 . 137 .061 685 305
STREETS- INCLUDING SIDEWALKS
BRIDGES AND CULVERTS EXCEPT MILES
TOLL BRIDGES & DRAWBRIDGES 0379* 10 17. 10 6 .08 171 61
9TH AVE & STREET, GREELEY, COLORADO
0122* A-108,932 .383 .0182 417 20
1027-10TH STREET, GREELEYL COLORADO
0122* A-8,800 .383 .0182 34 2
0147S* A-12 , 160 .189 .0085 23 1
ISLAND GROVE PARK, GREELEY_, COLORADO
0122* A-12,158 .383 .0182 47 2
0191S* A-13, 500 .296 .0049 40 1
03018* B-100 FLAT ARGE
1 1
FOR MINIMUM 5 11
C-11167 7-66 PRINTED IN u.S.A. 1266 8810
DECLARATIONS SCHEDULE—General Liability Hazards No._ - Policy No. _NSL 2251 201
—— Description of Hazards Code No. I Premium Bases Rates Advance Premium
BI PD BI PD
A-MUNICIPAL , TOWNSHIP, COUNTY
OR STATE EMPLOYEES-N .O . C. 2457 C-607 , 500 .0151 .010 92 6$
POLICEMAN 3762 C-140 , 000 .104 .0286 146 40
AUTOMOBILE GARAGES , REPAIR
SHOPS , SALES AGENCIES OR
STBRAGE GARAGES , ALL EMPLOYEES
OTHER THAN AUTOMOBILE SALES-
MEN, INCLUDING PARTS DEPART-
MENT EMPLOYEES 3437 C-52 ,300 .083 .070 43 37
STREET OR ROAD PAVING OR
REPAVING , SURFACING OR
RESURFACING OR SCRAPING
( I .318 II .141 ) 5506 C-530,000 .342 .335 1 813 1776
EXCESS LIMITS CHARGE 9890 10 5
B-MUNICIPAL , STATE OR FEDERAL
OFFICE BUILDING ELEVATORS EACH
NOT ONE STORY 0$5* 4 61 . 56 2 .126 246 9
HOSPITAL ELEVATORS-NOT PUSH
BUTTON CONTROLLES OR ONE- EACH
STORY 057* 1 7 .20 2 .126 42 2
C-CONSTRUCTION OPERATIONS-
OWNER-N .O . C . ( NOT RAILROADS)
EXCLUDING OPERATIONS ON MINIMUM
BOARD SHIPS 0512 E- IF ANY .0133 .0070 16 11
D-STORES-REFRESHMENT STANDS MINIMUM
( SUBJ TO END G611 ) 1172 G-2 ,500 .0590 .0057 25 9
C-11167 7-66 PRINTED IN V.S.A. 1266 8810
DECLARATIONS SCHEDULE—Automobile Liability Hazards No. 4 - Policy No. NSL 2251 201
In the Rates and Advance Premium columns"BI"means"Bodily Injury Liability","PD"means"Property Damage Liability"and"Med.Pays."
means "Division 1. Medical Payments".
Description of Hazards Advance Premium
BI PD Med.Pays.
1. Owned Automobiles Premium Basis—Per Automobile
See other Declarations Schedule(s)—Automobile Liability Hazards 1 700 1 572
2. Hired Automobiles Premium Basis—Cost of Hiret
Locations Where Automobiles Purposes Estimated Rates per$100 Cost of Hire
Types Hired Will Be Principally Used of
+ Cost of
Use Hire BI PD
COMM'L GREELEY, COLORADO CL8 IF ANY .245 .211
INCLU ED
P. P. GREELEY, COLORADO P&B IF ANY .491 .307
3. Non-Owned Automobiles Premium Basis—Class 1 Persons and Class 2 Employeesf
Class 1 Persons— Location of Headquarters
Rates per Person
Name of Each of Persons Named Herein BI PD
38 GREELEY, COLORADO 1 .963 1 .15 75 44
Class 2 Employees— Location of Headquarters
Rates per Employee
Estimated Average Number of Class 2 Employees BI PD
400 GREELEY, COLORADO .167 .077 67 31
/0i.:, / 117
"The purposes of use of the automobile are"Pleasure and Business"unless otherwise stated. The abbreviation"C"in the"Purposes of Use"column
shall mean "Commercial," the abbreviation "C-LT" shall mean "Commercial-(Local Truckman)" and the abbreviation "C-LHT" shall mean
"Commercial-(Long Haul Truckman)."
C-11177 7-66 PRINTED is U.S.A. NSL,SLA,BL
OSLSee over for Description of Premium Bases 8840
OSL,OSLA,OBL,MV 467 t p
DECLARATIONS SCHEDULE—Automobile Liability Hazards No. 5 Policy No. NSL 2251 201
Owned Automobiles
The purposes of use of the automobile are "Pleasure and Business" unless otherwise stated. The abbreviation "C" in the "Purposes of Use"
column shall mean "Commercial", the abbreviation "C—LT" shall mean "Commercial—(Local Truckman)" and the abbreviation "C—LHT"
shall mean "Commercial—(Long Haul Truckman)". The abbreviation"UM"preceding a premium in the Bodily Injury Liability premium column
shall mean "Premium for Uninsured Motorists Coverage"..
Number of Licensed Owned Automobiles, Exclusive of Trailers Average Graded Advance Premium Reduction %
Town and State Number and Purposes Rates Advance Premium s
in which the automobiles Class of of Bodily Property Division 1 Bodily Property Division I
will be principally garaged Automobiles Use Injury Damage Medical Injury Damage Medical
Liability Liability Payments Lability Liability Payments
ROAD DISTRICT NO. 1 1 6-6 P&B 23 15 23 15
1 10% OF 8CA 3E 8CA C 9 9 324 324
5 50% OF 8CA ". )8C C 1 1 1 1
2 BUSES 5 5 25 25
(0-30PAS 17 9 34 18
ROAD DISTRICT NO. 2 1 6-B P&B 23 15 23 15
36 8CA C 9 9 324 324
5 50%8C 5 5 25 25
ROAD DISTRICT NO . 3 1 6-B P&B 23 15 23 15
33 8CA C 9 9 297 298
1 10%8C C 1 1 1 1
15 50%8C C 5 5 75 75
CUSTODIAN 1 8CA C 9 9 9 9
CIVIL DEFENSE 1 8CA C 9 9 9 9
COUNTY CLERK 1 6-8 C 23 15 23 15
LIBRARY 2 8CA C 9 9 18 18
1 6-B C 23 15 23 15
COUNTY AGENT 7 8CA C 9 9 63 63
GENERAL HOSPITAL 1 6-B P&B 23 15 23 15
1 8CA C 9 9 18 18
SME 4 8CA C 9 9 36 36
1 50%8C C 5 5 5 5
( WELFARE 1 8CA C 9 9 9 9
`,COUNTY SHOP 2 6-B P&B 23 15 46 30
6 8CA C 9 9 54 54
2 50%8C C 5 5 10 10
C-11179 7-66 PRINTED IN as.a. NSL, SLA, MV, BL
ONSL,OSLA,001.111,OBL 8890
DECLARATIONS SCHEDULE—Automobile Liability Hazards No. 6 Policy No. NSA 2251 201
Owned Automobiles
The purposes of use of the automobile are "Pleasure and Business" unless otherwise stated. The abbreviation "C" in the "Purposes of Use"
column shall mean "Commercial", the abbreviation "C—LT" shall mean "Commercial—(Local Truckman)" and the abbreviation "C—LHT"
shall mean "Commercial—(Long Haul Truckman)". The abbreviation"UM"preceding a premium in the Bodily Injury Liability premium column
shall mean "Premium for Uninsured Motorists Coverage".
Number of Licensed Owned Automobiles, Exclusive of Trailers Average Graded Advance Premium Reduction
Town and State Number and Purposes Rates Advance Premiums
in which the automobiles Class of of Bodily Property Division 1 Bodily Property Division I
will be principally garaged Automobiles Use Injary Damage Medical Injury Damage Medical
Liability Liability Payments Liability Liability Payments
SHERIFF 8 170% C 21 15 168 120
BASE PREN
2 10%8CA C 1 1 2 2
NURSING HOME 1 8CA C 9 9 9 9
/'(•
C-11179 7-66 PRINTED IN U.S.A. ONSL,OSLA,OOM 8890
V,OBL
This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following:
OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE
RESIDENCE, APARTMENT AND TWO FAMILY DWELLING
It is agreed that the insurance applies to the insured premises, subject to the following additional provisions:
1. The definition of "insured premises" is amended to read as follows:
"insured premises" means the premises described below or designated in the policy as subject to this endorsement,
including the ways immediately adjoining and including garages and stables incidental thereto, gardens incidental
thereto on land not owned by the named insured, and individual or family cemetery plots or burial vaults.
2. With respect to operations at such premises exclusion (o) does not apply, provided such operations are not for the
purpose of changing the use of such premises to other than exclusive use as a one or two family dwelling, and ex-
clusion (m) is deleted;
3. If the named insured is an individual, the "Persons Insured" provision includes, if residents of the named insured's
household, the named insured's spouse and the relatives of either the named insured or such spouse under the age of
twenty-one.
4. The insurance does not apply to bodily injury or property damage:
(a) arising out of the ownership, maintenance or use, or any operations necessary or incidental thereto, of any por-
tion of the insured premises on which a trade, profession or business is conducted or which is designed or held
for such purposes, provided incidental office, professional, private school or studio occupancy of the premises,
the renting of accommodations at the premises to not more than two roomers or boarders and the renting or hold-
ing for rental at the premises of not more than three car spaces or stalls shall not be considered a business;
(b) due to the rendering of or failure to render any professional service;
(c) caused by any dog owned by the insured while such dog is away from the insured premises;
(d) arising out of the use of bicycles by or on behalf of the insured for trade, professional or business purposes.
Description of Premises:
Amending Policy No.
TIIE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY
Secretary Secretary
C-11457 7-66 PRINTED IN U.S.A. N.S. 6210
This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following:
COMPREHENSIVE GENERAL LIABILITY INSURANCE
OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE
EXCLUSION
(Fairs)
It is agreed that the insurance applies with respect to the operation of any fair out of doors subject to the following additional
exclusions:
The insurance does not apply
1. to bodily injury or property damage arising out of
(a) mechanically operated amusement devices owned or operated by the named insured,
(b) automobile or motorcycle racing or stunting,
(c) rodeos, or
2. to bodily injury to any person while practicing for or participating in any contest or exhibition of an athletic or sports
nature sponsored by the named insured.
THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE�CE COMPANY
�
�i�� Sec ,i� Y 4Gs� e�"�
Secretary
C-11288 7-66 PRINTED IN O.S.A. N.S.
G309
This endorsement 01odifies such insurance as is afforded by the provisions of the policy relating to the following:
COMPREHENSIVE GENERAL LIABILITY INSURANCE
MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE
OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE
EXCLUSION
(Malpractice and Professional Services)
(Form A)
It is agreed that with respect to any operation described below or designated in the policy as subject to this endorsement, the
insurance does not apply to bodily injury or property damage due to
I. the rendering of or failure to render
(a) medical, surgical, dental, x-ray or nursing service or treatment, or the furnishing of food or beverages in connection
therewith;
(b) any service or treatment conducive to health or of a professional nature; or
(c) any cosmetic or tonsorial service or treatment;
2. the furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances; or
3. the handling of or performing of autopsies on dead bodies.
Description of Operations:
Amending Policy No.
THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY
Secretory Secretary
C-11293 7-66 PRINTED IN U.s.A. N.S.
G314
This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following:
COMPREHENSIVE GENERAL LIABILITY INSURANCE
MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE
OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE
PRODUCTS HAZARD EXCEPTIONS
It is agreed that the products hazard does not include bodily injury or property damage arising out of the named insured's
products manufactured, sold, handled or distributed in connection with(1) the use of any premises described in this endorse-
ment, owned by or rented to the named insured or (2) any operation, described in this endorsement, conducted by or on behalf
of the awned insured.
Description of Premises and Operations:
Amending Policy No.
THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY
Secretary Secretary
C-11333 7-66 PRINTED IN U.S.A. N.S. G610
COMPREHENSIVE GENERAL LIABILITY INSURANCE COVERAGE PART
I. Coverage A—Bodily Injury Liability • tributing, selling or serving alcoholic beverages or as an
owner or lessor of premises used for such purposes, by
Coverage B—Property Damage Liability reason of the selling, serving or giving of any alcoholic
The company will pay on behalf of the insured all sums which the beverage
insured shall become legally obligated to pay as damages because (1) in violation of any statute, ordinance or regulation,
of
Coverage A. bodily injury or (2) to a minor,
Coverage B. property damage (3) to a person under the influence of alcohol, or
to which this insurance applies, caused by an occurrence, and the (4) which causes or contributes to the intoxication of any
company shall have the right and duty to defend any suit person;
against the insured seeking damages on account of such bodily (g) to any obligation for which the insured or any carrier as his
injury or property damage, even if any of the allegations of the insurer may be held liable under any workmen's compen-
suit are groundless, false or fraudulent, and may make such sation, unemployment compensation or disability benefits
investigation and settlement of any claim or suit as it deems law, or under any similar law;
expedient, but the company shall not be obligated to pay any
claim or judgment or to defend any suit after the applicable limit (h) to bodily injury to any employee of the insured arising out
of the company's liability has been exhausted by payment of of and in the course of his employment by the insured;but
judgments or settlements. this exclusion does not apply to liability assumed by the
insured under an incidental contract;
Exclusions (i) to property damage to
(1) property owned or occupied by or rented to the insured,
This insurance does not apply:
(2) property used by the insured, or
(a) to liability assumed by the insured under any contract or
agreement except an incidental contract; but this exclusion (3) property in the care, custody or control of the insured
does not apply to a warranty of fitness or quality of the or as to which the insured is for any purpose exercising
named insured's products or a warranty that work per- physical control;
formed by or on behalf of the named insured will be done in but parts (2) and (3) of this exclusion do not apply with
a workmanlike manner; respect to liability under a written sidetrack agreement and
part (3) of this exclusion does not apply with respect to
(b) to bodily injury or property damage arising out of the owner- property damage (other than to elevators)arising out of the
ship, maintenance, operation, use, loading or unloading of use of an elevator at premises owned by, rented to or con-
(1) any automobile or aircraft owned or operated by or trolled by the named insured;
rented or loaned to the named insured, or (j) to property damage to premises alienated by the named
2 any other automobile or aircraft operated insured arising out of such premises or any part thereof;
( ) by any person
in the course of his employment by the named insured; (k) to bodily injury or property damage resulting from the failure
but this exclusion does not apply to the parking of an of the named insured's products or work completed by or for
automobile on premises owned by,rented to or controlled by the named insured to perform the function or serve the
the named insured or the ways immediately adjoining, if purpose intended by the named insured, if such failure is
such automobile is not owned by or rented or loaned to the due to a mistake or deficiency in any design,formula, plan,
named insured; specifications, advertising material or printed instructions
(c) to bodily injury or property damage arising out of and in the prepared or developed by any insured; but this exclusion
course of the transportation of mobile equipment by an does not apply to bodily injury or property damage
oducts resulting
automobile owned or operated by or rented or loaned to the from the active malfunctioning of such products or work;
named insured; (I) to property damage to the named insured's products arising
(d) to bodily injury or property damage arising out of the owner- out of such products or any part of such products;
ship, maintenance, operation, use, loading or unloading of (m)to property damage to work performed by or on behalf of the
any watercraft, if the bodily injury or property damage named insured arising out of the work or any portion there-
occurs away from premises owned by, rented to or con- of, or out of materials, parts or equipment furnished in
trolled by the named insured; but this exclusion does not connection therewith;
apply to bodily injury or property damage included within
the products hazard or the completed operations hazard or (n) to damages claimed for the withdrawal, inspection, repair,
resulting from operations performed for the named insured replacement, or loss of use of the named insured's products
by independent contractors or to liability assumed by the or work completed by or for the named insured or of any
insured under an incidental contract; property of which such products or work form a part, if
such products, work or property are withdrawn from the
(e) to bodily injury or property damage due to.war, whether or market or from use because of any known or suspected
not declared,civil war,insurrection,rebellion or revolution defect or deficiency therein.
or to any act or condition incident to any of the foregoing,
with respect to
(1) liability assumed by the insured under an incidental II. Persons Insured
contract,or
Each of the following is an insured under this insurance to the
(2) expenses for first aid under the Supplementary Pay- extent set forth below:
ments provision;
(a) if the named insured is designated in the declarations as an
(f) to bodily injury or property damage for which the insured or individual, the person so designated but only with respect
his indemnitee may be held liable, as a person or organi- to the conduct of a business of which he is the sole pro-
zation engaged in the business of manufacturing, dis- prietor;
(Continued on page 2) L 1
Page 2
(b) if the named insured is designated in the declarations as a Subject to the above provisions respecting "each person" and
partnership or joint venture, the partnership or joint "each occurrence", the total liability of the company for all
venture so designated and any partner or member thereof damages because of (1) all bodily injury included within the
but only with respect to his liability as such; completed operations hazard and (2) all bodily injury included
within the products hazard shall not exceed the limit of bodily
(c) if-the named insured is designated in the declarations as injury liability stated in the declarations as "aggregate".
other than an individual, partnership or joint venture, the
organization so designated and any executive officer,
director or stockholder thereof while acting within the Coverage B—The total liability of the company for all damages
scope of his duties as such; because of all property damage sustained by one or more persons or
organizations as the result of any one occurrence shall not exceed
(d) any person (other than an employee of the named insured) the limit of property damage liability stated in the declarations
or organization while acting as real estate manager for the as applicable to "each occurrence".
named insured;and
Subject to the above provision respecting "each occurrence", the
(e) with respect to the operation,for the purpose of locomotion total liability of the company for all damages because of all
upon a public highway,of mobile equipment registered under properly damage to which this coverage applies and described in
any motor vehicle registration law, any of the numbered subparagraphs below shall not exceed the
(i) an employee of the named insured while operating any limit of property damage liability stated in the declarations as
such equipment in the course of his employment, and "aggregate":
(ii) any other person while operating with the permission (1) all properly damage arising out of premises or operations
of the named insured any such equipment registered in rated on a remuneration basis or contractor's equipment
the name of the named insured and any person or rated on a receipts basis, including property damage for
organization legally responsible for such operation, but which liability is assumed under any incidental contract
only if there is no other valid and collectible insurance relating to such premises or operations, but excluding
available, either on a primary or excess basis, to such property damage included in subparagraph (2) below;
person or organization; (2) all properly damage arising out of and occurring in the
provided that no person or organization shall he an insured course of operations performed for the named insured by
under this paragraph (e) with respect to: independent contractors and general supervision thereof by
the named insured, including any such property damage for
(1) bodily injury to any fellow employee of such person which liability is assumed under any incidental contract
injured in the course of his employment, or relating to such operations,but this subparagraph(2)does
(2) property damage to property owned by, rented to, in not include property damage arising out of maintenance or
repairs at premises owned by or rented to the named
charge of or occupied by the named insured or the
employer of any person described in subparagraph(ii). insured or structural alterations at such premises which do
not involve changing the size of or moving buildings or
This insurance does not apply to bodily injury or property damage other structures;
arising out of the conduct of any partnership or joint venture of (3) all property damage included within the products hazard and
which the insured is a partner or member and which is not all property damage included within the completed operations
designated in this policy as a named insured.
hazard.
Such aggregate limit shall apply separately to the property
III. Limits of Liability damage described in subparagraphs (1), (2) and (3), above, and
under subparagraphs(1)and(2), separately with respect to each
Regardless of the number of (1) insureds under this policy, (2) project away from premises owned by or rented to the named
persons or organizations who sustain bodily injury or property insured.
damage, or(3)claims made or suits brought on account of bodily
injury or property damage, the company's liability is limited as
follows: Coverages A and B—For the purpose of determining the limit of
the company's liability, all bodily injury and properly damage
Coverage A—The limit of bodily injury liability stated in the arising out of continuous or repeated exposure to substantially
declarations as applicable to "each person" is the limit of the the same general conditions shall be considered as arising out of
company's liability for all damages because of bodily injury one occurrence.
sustained by one person as the result of any one occurrence; but
subject to the above provision respecting"each person",the total
liability of the company for all damages because of bodily injury IV. Policy Period;Territory
sustained by two or more persons as the result of any one occur-
rence shall not exceed the limit of bodily injury liability stated in This insurance applies only to bodily injury or property damage
the declarations as applicable to"each occurrence". which occurs during the policy period within the policy territory.
C-11139 Edition July I,1966 PAINTED IN U.S.A. A.S.(CGL) L 1
COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE COVERAGE PART
I. Coverage C—Bodily Injury Liability • (1) a lessee or borrower of the automobile, or
Coverage D—Property Damage Liability (2) an employee of the named insured or of such lessee or
borrower;
'Ile company will pay on behalf of the insured all sums which the
insured shall become legally obligated to pay as damages because (d) any other person or organization but only with respect to
of his or its liability because of acts or omissions of an insured
Coverage C. bodily injury or under (a), (h)or (c)above.
Coverage I). property damage
None of the following is an insured:
to which this insurance applies, caused by an occurrence and
arising out of the ownership, maintenance or use, including
(i) any person while engaged in the business of his employer
loading and unloading, of any automobile, and the company shall
with respect to bodily injury to any fellow employee of
have the right and duty to defend any suit against the insured such person injured in the coupe of his employment;
seeking damages on account of such bodily injury or property
damage, even if any of the allegations of the suit are groundless, (ii) the owner or lessee (of whom the ne,nod insured is a sub-
false or fraudulent, and may make such investigation and settle- lessee) of a hired automobile or the owner of a non-rnuned
ment of any claim or suit as it deems expedient, but the company automobile,or any agent or employee of any such owner or
shall not be obligated to pay any claim or judgment or to defend lessee;
any suit after the applicable limit of the company's liability has
been exhausted by payment of judgments or settlements. (iii) an executive officer with respect to an automobile owned by
him or IA a member of his household;
Exclusions (iv) any person or organization, other than the named insured,
with respect to:
apply;
This insurance does not a I
(a) to liability assumed by the insured under any contract or (1) a motor vehicle while used with :my trailer owned or
agreement; hired by such person or organization and not covered
by like insurance in the company (except a trailer
(b) to any obligation for which the insured or any carrier as his designed for use with a private passenger automobile
insurer may be held liable under any workmen's compete and not being used fur business purposes with another
sation, unemployment compensation or disability benefits type motor vehicle), or
law, or under any similar law;
(2) a trailer while used with any motor vehicle owned or
(c) to bodily injury to any employee of the insured arising out hired by such person or organization and not covered
of and in the course of his employment by the insured, but by like insurance in the company
this exclusion does not apply to any such injury arising out
of and in the course of domestic employment by the insured (v) any person while employed in or otherwise engaged in
unless benefits therefor arc in whole or in part either pay- duties in connection with an automobile business, other
able or required to be provided under any workmen's than an automobile business operated by the named insured.
compensation law;
(d) to property damage to This insurance does not apply to bodily injury or property damage
arising out of (1) a non-owned automobile used in the conduct of
(1) property owned or being transported by the insured,or any partnership or joint venture of which the insured is a partner
as a unmet
(2) property rented to or in the care,custody or control of or member and which is not designated in this policy
insured,or(2)if the named insured is a partnership,an automobile
the insured,or as to which the insured is for any purpose
exercising physical control, other than properly damage owned by or registered in the panne of a partner [hereof.
to a residence or private garage by a private passenger
automobile covered by this insurance;
(e) to bodily injury due to war, whether or not declared, civil III. Limits of Liability
war, insurrection, rebellion or revolution or to any act or Regardless of the number of (I) insureds under this policy, (2)
condition incident to any of the foregoing, with respect to persons or organizations who sustain bodily injury or property
expenses for first and under the Supplementary Payments damage, (3) claims made or suits brought on account of bodily
provision. injury or property damage or (4) automobiles to which this policy
applies, the company's liability is limiter) as follows:
II. Persons Insured
Coverage C—The limit of bodily injury liability stated in the
Each of the following is an insured under this insurance to the
extent set forth below: declarations as applicable to each person is the limit of the
company's liability for all damages because of bodily injury
(a) the named insured; sustained by one person as the result of any one occurrence; but
subject to the above provision respecting"each person", the total
(b) any partner or executive officer thereof, but with respect to liability of the company for all damages because of bodily injury
a non-owned automobile only while such automobile is being sustained by two or more persons as the result of any one occur-
used in the business of the named insured; rence shall not exceed the limit of bodily injury liability stated in
the declarations as applicable to "each occurrence".
(c) any other person while using an owned automobile or a
hired automobile with the permission of the named insured,
provided his actual operation or(if he is not operating)his Coverage D—The total liability of the company for all damages
other actual use thereof is within the scope of such per- because of all property damage sustained by one or more persons or
mission, but with respect to bodily injury or property organizations as the result of any one occurrence shall not exceed
damage arising out of the loading or unloading thereof,such the limit of property damage liability stated in the declarations as
other person shall be an insured only if he is: applicable to "each occurrence".
(Continued on page 2) L 2A
Page 2
Coverages C and D—For the purpose of determining the limit of loaned to, the named insured, provided such automobile is not
the company's liability, all bodily injury and property damage owned by or registered in the name of(a)a partner or executive
arising out of continuous or repeated exposure to substantially officer of the named insured or(b)an employee or agent of the
the same general conditions shall be considered as arising out of named insured who is granted an operating allowance of any
one occurrence. sort for the use of such automobile;
"non-owned automobile"means an automobile which is neither
an owned automobile nor a hired automobile;
IV. Policy Period;Territory
"owned automobile"means an automobile owned by the named
This insurance applies only to bodily injury or property damage insured;
which occurs during the policy period within the territory
described in paragraph (1) or (2) of the definition of policy "private passenger automobile" means a four wheel private
territory. passenger or station wagon type automobile;
"trailer" includes semi-trailer but does not include mobile
V. Additional Definitions equipment.
When used in reference to this insurance(including endorsements
forming a part of the policy): VI. Additional Condition
"automobile business" means the business or occupation of Excess Insurance—Hired and Non-Owned Automobiles
selling, repairing, servicing, storing or parking automobiles;
With respect to a hired automobile or a non-owned automobile,this
"hired automobile" means an automobile not owned by the insurance shall be excess insurance over any other valid and
named insured which is used under contract in behalf of, or collectible insurance available to the insured.
C-11952 Edition October 1,1966 PRI NIPD IN U.S.A. N.S. (CAL) L 2A
HOSPITAL PROFESSIONAL LIABILITY INSURANCE COVERAGE PART
ADDITIONAL DECLARATIONS n
forming part of Policy No. NSL 2251 a°1
Coverage Limits of Liability Advance Premium
O. Hospital Professional Liability $ 300 ,000 $ 168
each claim
$ 500,000 aggregate $
1 Total Advance Premium $ 1 68
General Liability Hazards
Description of Hazards(State Name;whether operated
not-for-profit;Kind of cases cared for;
School of Medicine In charge) Ad
_Code No. Premium Bases-` Rates Premiums
A-Beds A-Each
B-Out-Patients B-Per$100
Visits
CONVALESCENT OR NURSING
HOMES-NOT MENTAL-PSYCHO-
PATHIC INSTWTUTION
GOVERMENTAL MINIMUM
PER BED 5428 A - 97 3.36 168
Minimum Premium Per Location per Annum$
(Continued on Page 2) L 22
Page 2
I. COVERAGE O—HOSPITAL PROFESSIONAL LIABILITY ♦ II. PERSONS INSURED
The company will pay on behalf of the insured all sums Each of the following is an insured under this insurance
which the insured shall become legally obligated to pay as to the extent set forth below:
damages because of injury to any person arising out of the (a) the named insured;
rendering of or failure to render,during the policy period, f
the following professional services: (b) tithe na a insured is designated in the declarer
tions as a partnership, any partner or member
(a) medical, surgical, dental or nursing treatment to thereof, but only with respect to his liability as
such person or the person inflicting the injury in- such;
eluding the furnishing of food or beverages in con- (c) if the named insured is designated in the declara-
nection therewith, tions as other than an individual or partnership,
(b) furnishing or dispensing of drugs or medical,dental any executive officer, stockholder or member of
or surgical supplies or appliances if the injury the board of trustees, directors or governors of the
occurs after the named insured has relinquished named insured while acting within the scope of his
possession thereof to others, duties as such.
(c) handling of or performing post-mortem examina- III. LIMITS OF LIABILITY
tions on human bodies, or
Regardless of the number of insureds under this insur-
(d) service by any person as a member of a formal ance the company's liability is limited as follows:
accreditation or similar professional board or The limit of liability stated in the declarations as ap-
committee of the named insured, or as a person plicable to "each claim" is the limit of the company's
charged with the duty of executing directives of liability for all damages because of each claim or suit
any such board or committee, covered hereby. The limit of liability stated in the de-
and the company shall have the right and duty to defend clarations as "aggregate" is, subject to the above pro-
any suit against the insured seeking such damages, even vision respecting "each claim", the total limit of the
if any of the allegations of the suit are groundless, false company's liability hereunder for all damages.
or fraudulent, and may make such investigation and,
with the written consent of the insured, such settlement IV. AMENDED DEFINITION
of any claim or suit as it deems expedient, but the com- When used in reference to this insurance "damages"
pany shall not be obligated to pay any claim or judg- means all damages, including damages for death, which
meet or to defend any suit after the applicable limit of are payable because of injury to which this insurance
the company's liability has been exhausted by payment applies.
of judgments or settlements.
V. ADDITIONAL CONDITIONS
Exclusions A. Insured's Duties in the Event of Injury,Claim or Suit When an
1 injury occurs written notice shall be given by or on
This insurance does not apply:y: behalf of the insured, in accordance with the "In-
(a) to bodily injury to any employee of the insured sured's Duties in the Event of Occurrence, Claim or
arising out of and in the course of his employment Suit" Condition.
by the insured; B. First Aid Exclusion The insurance shall not apply to
(b) to any obligation for which the insured or any expenses incurred by the insured for first aid at the
carrier as his insurer may be held liable under any time of an accident and the "Supplementary Pay-
workmen's compensation, unemployment com- ments" provision and the "Insured's Duties in the
pensation or disability benefits law, or under any Event of Occurrence, Claim or Suit" Condition are
similar law; amended accordingly.
(c) to liability of an insured, if an individual, for his C. Limitation of Coverage Under Any Other Liability Insurance
personal acts or omissions of a professional nature; Except as stated in this Part, the policy does not
(d) to the ownership, maintenance, operation, use, apply to injury arising out of the rendering of or failure
loading or unloading of any motor vehicle, trailer, to render the professional services described in para-
watercraft or aircraft. • graph I above.
C-11540 Edition October 1,1966 FRI NT ED in U.S.A. N.S.(HPL) L R2
HAROLD W. ANDERSON. CHAIRMAN JOHNSTOWN U V tv C®u ht-r
EDWARD L. DUNBAR, CHAIRMAN PRO•TEM I t •"` ��
1223 29RD AVENUE CT..GREELEY c t L1:�`OF��T ADO.
MARSHALL H. ANDERSON, MEMBER �3 t ,.+
2412 BTH AVENUE.GREELEY OFFICE OF THE BOARD OF COUNTY COMMISSIONERS
SAMUEL S. TELEP
COUNTY ATTORNEY / ESLEV C
b LO
ANN S CLERK.OFC BOAR CLERK
AND CLERK 22 BOARD January 29, 1968
PHONE 899-2212 EXT.21
LHR 114
RECEIVED THIS 29th DAY OF JANUARY, 1968, THE FOLLOWING LISTED
INSURANCE POLICY:
Property Floater Policy, #PF 896363 in the amount of $221,000.00,
The Connecticut Fire Insurance Company, Agent- Lott Agency, Inc.
expiration date August 9, 1968.
THE ABOVE POLICY NOW CONSOLIDATED INTO POLICY #6256402, THE
TRAVELERS INDEMNITY COMPANY. SEE LHR 115
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