HomeMy WebLinkAbout871762.tiff Certificate of Insurance I
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 —
Daniels & Associates, Inc. et al 7 Name and LIBERTY
address of MUTUAL,
Southwest Cablevision, LTD Insured.
(Formerly Northern Colorado Video, Inc.)
8q
3737 West /1�0thStreet I
a. di TFiccskUe1e bEYhis c&M&M. insured by the Company under the palicyllest listed below. *The insurance afforded by me Lared pohcy! es! is subtect to
their terms exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to why:" 'his cernfica.e
may be issued.
ITYPE OF POLICY CERT. EXP. DATE POLICY NUMBER LIMITS OF LIABILITY
COVERAGE AFFORDED UNDER W.C. COV. B
i
LAW OF THE FOLLOWING STATES BODILY INJURY BY ACCIDENT
WORKERS' S 500,000 EA ACCIDENT
BODILY INJURY BY DISEASE
COMPENSATION 4-1-88 WC2-191-075250-017 CO, FL, LA, NV, NC
s 500,000 EA. PERSON
SC, GA, KS, TX, UT, BODILY INJURY BY DISEASE
VA, TN, CA
s 500,000 POLICY LIMIT
reu
Al COMPREHENSIVE BODILY INJURY PROPERTY DAMAGE
FORM —1
Li SCHEDULE FORM EACH EACH
$ OCCURRENCE $ OCCURRENCE
PRODUCTS COM-
-')- ® LETED OPERATIONS $ AGGREGATE $ AGGREGATE
< I_ X Premises &
L.
Z m 0perations
w Q It DEPENDENT CON- 4-1-88 LG1-191-075250-037 COMBINED SINGLE LIMIT
0 .7, I TRACTORS:'CONTRAC BODILY INJURY AND PROPERTY DAMAGE
TORS PROTECTIVE
$ 1,000,000 EACH OCCURRENCE
CONTRACTUAL $ 1 AGGREGATE
LX LIABILITY ,000,000
L7L Broad Form
O $I OWNED
AS1-191-075250-027 $ 1.000.000 EACH ACCIDENT SINGLE LIMIT-B.I. AND P.D. COMBINED
D --1"
_ $ EACH PERSON
o] NON.OWNED 4-1-88
Q AE1-191-075250-057 EACH ACCIDENT EACH ACCIDENT
�i HIRED I $ OR OCCURRENCE $ OR OCCURRENCE
Umbrella
Excess 4-1-88 LE1-191-075250-047 Limit of Liability: $5,000,000
uc oe Liability
x
i-
0
LOCATIONISI OF OPERATIONS&JOB 9 Ill Applicable; DESCRIPTION OF OPERATIONS
All Locations - All Operations It is hereby agreed that Weld County Board of Commissioners i
named additional insured as their interest may appear, as respects to General Liabilit
•NorE You.al NOT be..00hed nraan'Jy at.he canunoatio„of hit coverage Paa wiy be-.-a ea it thus overage s ie mi,aied or,wrcea
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:
(....;_.
Weld County Board of Commissioners F -
915 10th Street, P.O. Box 459 ° ` 3 d'C` ��f
Greele , CO 80631 AUTHORIZED REPRE NranvE
CERTIFICATE y
HOLDER-A Attn: M.A. Guerstein 4-1-87 Englewood
DATE ISSUED OFFICE
H
Tbn certificate a executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Camaame,. Ed rnf/
871762 Liberty !Mutual il�
Insurance Croup SI
EIS-74S PR
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