HomeMy WebLinkAbout000184.tiff THE HARTFORD js' t ` �, U
The Insurance People of ITT
San Francisco Regional Office
455 Market Street
P.O. Box 3615
April 10, 1989 San Francisco, CA 94119
Telephone(415)995-3200
Ms. Kathie Wagner
FRED S. JAMES & CO. OF COLORADO, INC.
2000 South Colorado Boulevard
P.O. Box 24789
Denver, Colorado 80224-0789
Re: WELD COUNTY GL-19628
Dear Kathie:
Enclosed for the above captioned Policyholder are three copies of the
Amendatory Rider changing the number of eligible participants and the Stop
Loss Determinant Factor under the Aggregate Stop Loss Agreement.
Please obtain the necessary signatures and return the signed copy stamped
"Execute and Return to Home Office" to my attention as soon as possible.
The remaining copies are for the Policyholder and your files.
If you have any questions, please do not hesitate to call.
Regards,
4i±n
RE-s'LU
Lastenita Casco
Administrative Service Representative App
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Hartford Fire Insurance Company and its Affiliates
Hartford Plaza,Hartford, Connecticut 06115
AMENDATORY RIDER
This rider forms a part of the Aggregrate Excess Risk Insurance Agreement
bewteen HARTFORD ACCIDENT AND INDEMNITY COMPANY and the Policyholder,
WELD COUNTY
Rider Effective Date: As of the dates stated below
The Agreement is hereby amended as follows:
1 . Effective January 1 , 1988, the "Reported Number of Eligible Employee
Participants" appearing in the Schedule is amended to:
Reported Number of Eligible Employee Participants
659
2. Effective January 1 , 1989 the "Excess Risk Determinant Factor" appearing
in the schedule is amended as follows:
Excess Risk Determinant Factor: $212.80
In all other respects , the Agreement remains the same.
Signed by the Insurance Company on April 6, 1989.
Secretary Registrar
Accepted
by S/ 4--A-c-73 S—S-9f
(Date)
AMENDATORY RIDER
This rider forms a part of the Aggregrate Excess Risk Insurance Agreement
bewteen HARTFORD ACCIDENT AND INDEMNITY COMPANY and the Policyholder,
WELD COUNTY
Rider Effective Date: As of the dates stated below
The Agreement is hereby amended as follows:
1 . Effective January 1 , 1988, the "Reported Number of Eligible Employee
Participants" appearing in the Schedule is amended to:
Reported Number of Eligible Employee Participants
659
2. Effective January 1 , 1989 the "Excess Risk Determinant Factor" appearing
in the schedule is amended as follows:
Excess Risk Determinant Factor: $212.80
In all other respects, the Agreement remains the same.
Signed by the Insurance Company on April 6, 1989.
CZ5Q.Afrietita
5�etary �l• Registrar
Accepted
by -s/6- -cv) r / ' I
(Date)
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