HomeMy WebLinkAbout881354.tiff ACONt11. �TIF ! . OF i � ISSUE DATE(MMIDDIVV)
04-07-89
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
EDWARD JACOBS & COMPANY NO
RIGHTS
TSO ALTER P THE COVERAGE AF
UPON
CERTIFICATE HOLDER.
H THIS
THE POLI
CIES BEL
OW
NOT AMEND,
SPECIAL RISKS DIVISION EXTEND
477 NINTH AVE. #107 COMPANIES AFFORDING COVERAGE
SAN MATEO, CA 94402
COMPANY A INSURANCE CO. OF NORTH AMERICA
LETTER
CODE SUB-CODE
COMPANY B CIGNA
LETTER
INSURED
UNITED ARTISTS COMM. , INC COMPANY PACIFIC EMPLOYERS INS. CO.
SOUTHWEST CABLEVISION (GREELEY) LETTER
3737 WEST 10TH STREET COMPANY
GREELEY, CO 80634 LETTER D
COMPANY E
#11002
LETTER
COVERAGESTHIS IS TO ERTIFY THAT THE<.. . f.
INDICATED, POLICIES
NOTW THSTANDING ANYREQUIREME T,TERM OR TO ABOVE POLICY
CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOW WHICH PERIOD
ECERTIFICATE MAY BE ISSUED OR XCLUSIONS AND CONDITIONS OFMAY SUCHERTAIN, THE INSURANCE AFFORDED BY THE POLICIES POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
CLAIMS.
CO POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS
LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $
A X COMMERCIAL GENERAL LIABILITY XSL GO 56 98 29-7 07-01-88 07-01-89 PRODUCTS-COMP/OPS AGGREGATE $ 500
CLAIMS MADE X OCCUR. PERSONAL&ADVERTISING INJURY $ 500
X OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 500
FIRE DAMAGE(Any one tire) $ 50
MEDICAL.EXPENSE(Any one person) $ 5
AUTOMOBILE LIABILITY COMBINED
SINGLE $ 1000
A X ANY AUTO ISA 0001848 07-01-88 07-01-89 UMIT
BODILY
ALL OWNED AUTOS INJURY $
(Per person)
SCHEDULED AUTOS
BODILY
HIRED AUTOS INJURY $
NON-OWNED AUTOS (Per accident)
GARAGE LIABILITY PROPERTY $
DAMAGE
EACH AGGREGATE
EXCESS LIABILITY OCCURRENCE
B XOO GO 56 98 28-5 07-01-88 07-01-89 $ 5000 $ 5000
X OTHER THAN UMBRELLA FORM
STATUTORY
WORKER'S COMPENSATION
C PWC C3 14 04 71-A 07-01-88 07-01-89 $ 1000 (EACH ACCIDENT)
AND $ 1000. (DISEASE-POLICY LIMIT)
EMPLOYERS'LIABILITY $ 1000 (DISEASE-EACH EMPLOYEE)
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED ON THE GENERAL LIAB.
POLICY ABOVE, IF REQUIRED BY WRITTEN CONTRACT.
CANCE1.tA'ION
CERt1i11CATE HOLDER`
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
WELD COUNTY BOARD OF COMMISSIONERS f EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
915 10TH STREET MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
P.O. BOX 459 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
GREELEY, CO 80631 LIABILITY OF ANY KIND UPON THE PANY,ITS GENTS OR REPRESENTATIVES.
ATTN. : M. A. GUERSTEIN AUTHORIZED REPRESENTATIVE
CRAIG J. NELSON - EXEC VP 881354
(CArQDn
AGORD lR.C(a/AR)
Hello