HomeMy WebLinkAbout901537.tiff r-'-'� ISSUE DATE(MM/DDITY)
Al:4asn® CERTIFICATE-OF INSURANCE
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
tl CI P I-'h'-'1 .',, "': NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,
- EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
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ii' <'A"''h COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER s "`T.ilii ir..11lH It it it:r[. t,f .
CODE SUB-CODE
COMPANY ct
ETTER
.:INSURED
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LETTER
3t))/(i i1'ignwAs ',- COMPANVD
LETTER
COMPANY E '.
LETTER
COVERAGESTHIS IS TO RTIFY THAT THE ;
R THE ICY INDICATED, OTW THSTANDINGOANYIREQUIREMENT N TERM OR CONDITION CE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE
OF ANY CO TRACTT OR OTHER DOCUMENT WITH REOSPECT TOLWHICH BTHIS
IOS
ECERTIFICATE MAY BE XCLUSIONS AND CONDITIONS OF SUCHEPOLICIESH LIMITS SHOWNE INSURANCE AFFORDED BY THE POLICIES MAY HAVE BEEN REDUCED BY PAID BED CLAIMS
REIN IS SUBJECT TO ALL THE TERMS,
CLAIMS
'CO POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS
'!LTR TYPE OF INSURANCE DATE(MM/DD/YY) DATE(MM/DD/YY) -
GENERAL AGGREGATE $ , 000
GENERAL LIABILITY C1 0 ti
A u, {)�,h b I. 4O I � C A .. ,i %O i e H 1%-)0/96 PRODUCTS-COMPIOPS AGGREGATE $ ,
r. COMMERCIAL GENERAL LIABILITY -
PERSONAL 8 ADVERTISING INJURY $ 1 0 )
' CLAIMS MADE X OCCUR. , 1)O(I
OWNER'S 8 CONTRACTOR'S PROT. EACH OCCURRENCE $ '-
FIRE DAMAGE(Any one fire) $ U
MEDICAL EXPENSE(Any one person) $
COMBINED
AUTOMOBILE LIABILITY SINGLE $ � '
'. F; : ANY AUTO 1.9I- ,'y364 41.L_A I / 10/89 1.x. /30/91} LIMIT . , 00/-1 t
F
BODILY '-
X ALL OWNED AUTOS INJURY $
SCHEDULED AUTOS (Per person)
BODILY
?'. HIRED AUTOS INJURY $
1 NON-OWNED AUTOS (Per accident)
GARAGE LIABILITY PROPERTY $
DAMAGE
i
EACH AGGREGATE
EXCESS LIABILITY OCCURRENCE _
�, t, 11 "Ir)11(' ' IFl i :tin I (Ksb4r3"?3WCA .11,' ;;0/83 ' -1 /30/90 $ . , 006 $ ' , 000
OTHER THAN UMBRELLA FORM
STATUTORY
WORKER'S COMPENSATION $ (EACH ACCIDENT)
AND $ (DISEASE-POLICY LIMIT)
EMPLOYERS'LIABILITY $ (DISEASE-EACH EMPLOYEE)',
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
Al ' OPEUATTON.> _. At , LOCATION:-
Named as additional insured: Weld County, Colorado 801537
Project No. : 90-13
!CERTIFICATE HOLDER CANCELLATION
I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
WELD COUNTY MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
DEPARTMENT OF ENGINEERING LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
933 N. 11th Street LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
GREELEY, CO 80631 AUTHORIZED REP SENTATIVE
ACORD 254(3/88) ____--.__._..__ CACORD CORPORATION 1988 I
Certificate of lnsurance
CERiif?CATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE
POUCY AND DOES NOT AMEND.EXTEND,OR ALTER THE CON .E AFFORDED BY THE POLICIES USTED BELOW.
This is to Certify that LIBERTY
Frontier Materials, Inc. & Frontier Sand MUTUAL
& Gravel, Inc. Name and
3600 Hwy. 52 M address of
Erie, CO 80516 Insured.
is, at the issue date of this certificate,insured by the Company under the policy(ies)listed below.The insurance afforded by the listed policy(ies)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 CERT.EXP.DATE"
LIMIT
OF ❑CONTINUOUS POLICY
POLICY ❑EXTENDED NUMBER OF
®POLICY TERM LIABILITY
COVERAGE AFFORDED UNDER W.C. EMPLOYER'S LIABIUTY
LAW OF THE FOLLOWING STATES: Bodily Injury By Accident
WORKERS' 1-1-91 WC2-191-089492-010 Colorado 100000 EaAcc.
Bodiy Injury By Disease
COMPENSATION 100,000 Ea Person
Body Injury By Disease
500,00(1 Fu.Limit
General Aggregate-Other than Products/Completed Operations
Products/Completed Operations Aggregate
J
IX
IX
z Bodily Injury and Property Damage Uabiliy
UJ
Olt' ❑CLAIMS MADE
per occurrence
personal and Advertising Injury
Q CO RETRO GATE
C)< per person/
WM Organization
2 Other
0 ❑OCCURRENCE
U
SPECIAL/EXCL
ENDORSEMENTS
❑OWNED EACH ACCIDENT-SINGLE LIMIT-B.I.AND P.D.COMBINED
OF-
m ❑NON-OWNED EACH PERSON
ct
EACH EACH ACCIDENT
❑HIRED OR OCCURIRENCE $ OR OCCURRENCE
CC
O
LOCATION(S)OF OPERATIONS 8 J08#(If Applicable) DESCRIPTION OF OPERATIONS:
'If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However,
you will not be notified annually of the continuation of coverage.
NOTICE OF CANCELLATION: THE COMPANY WILL NOT TERMINATE OR REDUCE Liberty Mutual
Insurance Group
THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNLESS DAYS
•
NOTICE OF SUCH TERMINATION OR REDUCTION HAS BEEN MAILED TO:
E
WELD COUNTY
CERTIFICATE DEPT. .OF ENGINEERING
HOLDER--r 933 N. 11th STREET
GREELEY, CO 80631 AUTHORIZED RE ESENTATIVE
L J Englewood
DATE ISSUED OFFICE
T h+a certificate is executed by UBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by Those Companies 13S772 R2
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