HomeMy WebLinkAbout881353.tiff Certificate of Insurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER.THIS CERTIFICATE IS NOT AN INSURANCE POLICY
AND DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
This is to Certify that LIBERTY
Daniels & Associates, Inc. et al Name and MUTUAL
Southwest Cablevision, LTD —-- addressof
3737 West 10th Street Insured,
Greeley, CO 80634
is,at the issue date of this certificate,insured by the Company under the policylies)listed below. The insurance afforded by the listed policyliesl is subject
to all their terms,exclusions and conditions and is not altered by any requirement,term or condition of any contract or other document with respect to which
this certificate may be issued.
TYPE OF POLICY CERT. EXP. DATE POLICY NUMBER LIMITS OF LIABILITY
• COVERAGE AFFORDED UNDER WC COV.B
LAW OF THE FOLLOWING STATES: Bodily Injury By Accident
WORKERS' 500,000 Ea.Act.
Bodily Injury By Disease
,, COMPENSATION 4-1-89 WC2-191••075250-0108 CA, CO, FL, LA, GA, 5000,000 Ea Person
HI, ID, KS, NC, SC, Bodily Injury By Disease
TX, UT, VA, TN 500,000 Pol Limit
IGeneral Aggregate Otner than Products:Completed Operations
2,000,000
Products:Completed Operations Aggregate
J
1,000,000
SBodily Injury and Poperty Damage Liability
4-1-89 TB1-191-075250-038 1 000 000 Per"Perreeee
} ❑ CLAIMS MADE Personal and Advertising Injury
H' per person:
aJ 1,000,000 organization
a CC Other
' W
J
2 OCCURRENCE
0
U --
SPECIALEXCL.
ENDORSEMENTS
0 H 2 OWNED AS1-191-075250-028 $ 1,000,000 EACH ACCIDENT-SINGLE LIMIT-B.I. AND P.D. COMBINED I'I
m ® NON-OWNED 4-1-89 $ EACH PERSON
Q Q EACH ACCIDENT EACH ACCIDENT
M HIRED AE1-191-07 5 250-058 $ OR OCCURRENCE $ OR OCCURRENCE
1 Umbrella Limit of Liability: $5,000,000 for Bodily
LIJ Excess 4-1-89 TH1-191-075250-048 Injury and Property Damage Over Underlying
o Liability Limits.
LOCATIONISI OF OPERATIONS &JOB N Of Applicable) DESCRIPTION OF OPERATIONS.
All Locations - All Operations It is hereby Egreed that Weld County Board of Commissioners )
named additional insured as their interest may appear, as respects to General Liability.
'NOTE:You will NOT be notified annually of the continuation of this coverage.You will be notified if this coverage is terminated or reduced.
NOTICE OF CANCELLATION: THE COMPANY WILL NOT TERMINATE OR •
REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNLESS
• 60 DAYS NOTICE OF SUCH TERMINATION OR REDUCTION HAS BEEN
MAILED TO:
r- Weld County Board of Commissioners 7 �) ��77
915 10th Street, P.O. Box 459 C c /a <�
CERTIFICATE Greeley, CO 80631 AUT ED R SENTATIVE
HOLDER -+ 4/1/88 Englewood
Attn: M. A. Guerstein DATE ISSUED OFFICE
This certificate is executed by LIBERTY MUTUAL INSURANCE COMPANY as respects such insurance as is afforded by That Cc 8 81 3F5,; —NTUAL FIRE INSURANCE COMPANY as
respects such insurance as is afforded by That Company,it is executed by LIBERTY INSURANCE CORPORATION as respects cup) rmpanV
,- 1( , �J� r'teS T)2
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