HomeMy WebLinkAbout990028.tiff ACORD CERTIFICATE OF LIABILITY INSURANCE DATE�MWDD YY)
PRODUCER 1/14/1999.:
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Riedman Corporation ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 1439 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Longmont, CO 80502-1439 COMPANIES AFFORDING COVERAGE
(303) 776-3421 Fax (303) 776-3219 COMPANY
INSURED A UNION INSURANCE
COMPANY
JOE & KELLY CLARK B
DBA JOE CLARK EXCAVATING OHIO CASUALTY
2202 VIVIAN COMPANY
C
LONGMONT CO 80501 COMPANY
0
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMSCO
LTR TYPE OF INSURANCE POLICY NUMBER I PoLN:Y EFFECTIVE POLICY EXPIRATION
GATE(MM/DD/YY) GATE(MWOD/TY) LIMBS
GENERAL LIABILITY UPK50215BT 01/26/99 01/26/00
GENERAL AGGREGATE $2.000.000
A ]( COMMERCIAL GENERALLIABILITYPRODUCTS-COMP/OP AGG 5 CLAIMS MADE $ OCCUR 2.000.000
PERSONAL&ADV INJURY 51.000.000
OWNER'S&CONTRACTOR'S PROT
EACH OCCURRENCE $1.000.000
FIRE DAMAGE(My one fire) $ 50,E
MED OW(My one person) $ 5 HNII
AUTOMOBILE LIABILITY 50432n1 01/26/99 01/26/00
B ANY AUTO COMBINED SINGLE LIMIT $ 500,000
ALL OWNED AUTOS
SCHEDULED AUTOS BODILY INJURY
(Per person)
HIRED AUTOS $
NON-OWNED AUTOS BODILY INJURY $
(Per accident)
PROPERTY DAMAGE
GARAGE LIABILITY
ANY AUTO
AUTO ONLY-EA ACCIDENT $
OTHER THAN AUTO ONLY.
EACH ACCIDENT $
EXCESS LIABILITYAGGREGATE $
_ UMBRELLA FORM EACH OCCURRENCE $
AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND $
EMPLOYERS' LIABILITYWC STAN- 0TH-
TORY LIMITS ER
THE PROPRIETOR/ INCL EL EACH ACCIDENT $
PARTNERSrEXECUTIVE EL DISEASE-POLICY LIMIT $
OFFICERS ARE: EXCL
OTHER EL DISEASE-EA EMPLOYEE $
DESCRIPTION OF OPERATIONS/LOCATINSNEHICLE&SPECIAL ITEMS
CERTWFICATE HOLDER CANCELLAihON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Weld County Government EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
915 10th S t. 70 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Greeley CO 80632 OF ANY Kelp UPON THE CO
MPANY. ITS AGENTS OR REPRESENTAIT/ES.
AUTHOR EPRESENTATWE h
Yd otifiSitIAAbr�'O ,L G? R.. //is/ (it z7 990028.,
CERTIFICATE OF INSURANCE COUNTY ISSUE DATE (MIM/DD/YY) : 01/08/1999 SMC
AGENT SA005996 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
�p6{ I 3 { $RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
RAND MORITZKY
1999 tEKT+END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
905 SOUTH FIELD STREET
LAKEWOOD CO 8092E .12 COMPANIES AFFORDING COVERAGE
INSURED CO-8080918 TO THE BOATCOMPANY NATIONAL FARMERS UNION PROPERTY AND CASUALTY COMPANY
A
NUNN TELEPHONE COMPANY COMPANY NATIONAL FARMERS UNION STANDARD INSURANCE COMPANY
B
P.O. BOX 148
NUNN CO 80648-0148 COMPANY
C
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM/DD/YY) DATE (MM/DD/YY)
8 GENERAL LIABILITY 2RU0162874 01/01/1999 01/01/2000 GENERAL AGGREGATE $
X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGO $ 2,000,000
- ❑CLAIMS MADE ❑X OCCURRENCE PERSONAL & ADV INJURY $ INCLUDED
X CONTRACTOR'S PROTECTIVE EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Any one fire) $ 50,000
MED EXP (Any one person) $ 5,000
B AUTOMOBILE LIABILITY 2RU01628T4 01/01/1999 01/01/2000 COMBINED SINGLE LIMIT $ 1,000,000
X ANY AUTO BODILY INJURY (per person) $
ALL OWNED AUTOS BODILY INJURY (per accident) $
--
SCHEDULED AUTOS PROPERTY DAMAGE $
HIRED AUTOS
-
NON-OWNED AUTOS
GARAGE LIABILITY AUTO ONLY - EACH ACCIDENT $
ANY AUTO
-
OTHER THAN AUTO ONLY: $
-
EACH ACCIDENT $
AGGREGATE $
B ''''''EE���XCESS LIABILITY 2000258132 01/01/1999 01/01/2000 EACH OCCURRENCE $ 1,000,000
]UMBRELLA FORM AGGREGATE $ 1,000,000
OTHER THAN UMBRELLA FORM $
WORKERS' COMPENSATION AND
EMPLOYERS' LIABILITY { STATUTORY LIMITS
-
EACH ACCIDENT $ 0
THE PROPRIETOR/ INCL. DISEASE - POLICY LIMIT $ 0
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL. DISEASE - EACH EMPLOYEE $ 0
OTHER
H REAL AND PERSONAL PROPERTY 2RU0162874 01/01/1999 01/01/2000 ALL OTHER PERIL $ 1,066,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS:
CERTIFICATE HOLDER CANCELLATION:
SHOULD ANY OF THE BOARD OF COUNTY COMMISSIONERS EXPIRATION DATE THEREOF, E DESCRIBED THE
THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30
COUNTY OF WELD DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE
TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
915 TENTH ST THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
GREELEY CO 80631 /,/E �'//
AUTHORIZED REPRESENTATIVE 1//� A oh,n ._ , 7&coig
I ♦
NATIONAL FARMERS UNION 11900 East Cornell Avenue
STANDARD INSURANCE COMPANY Aurora, Colorado 80014-3194
(303)337-5500
Rural Utilities Insurance Plan - Declarations
Customer # Policy # Policy Period FROM: 01/01/1999 TO: 01/01/2000 PREMIUM: $ 2,940
CO-8080918 2RU0162874 12:01 AM Standard Time at the address shown below. II PA: 52
Named Insured and Address: AGENT: SA005996 RAND MORITZKY
905 SOUTH FIELD STREET
NUNN TELEPHONE COMPANY LAKEWOOD CO 80226-4112
P.O. BOX 148 (303) 987-8281
NUNN, CO 80648-0148
INSURANCE APPLIES ONLY TO THOSE COVERAGES FOR WHICH A LIMIT OF LIABILITY IS SHOWN AND THIS COMPANY SHALL NOT
BE LIABLE FOR MORE THAN THE LIMIT OF LIABILITY SPECIFIED FOR EACH COVERAGE.
PROPERTY AND RELATED COVERAGES
LIMIT OF LIABILITY --- PROPERTY DEDUCTIBLES ---
Real and Personal Property $ 1,066,000 $ 1,000 Deductible Per Occurrence
Automatic Increase in Insurance 3.0 Percent
Personal Property of Others S 50,000
VALUE PROTECTION GROUP S 250,000 AGGREGATE LIMIT APPLIES TO ALL OF FOLLOWING:
Loss of Use $ Newly Acquired Property S
Accounts Receivable $ Property Off Premises $
Valuable Papers 8 Records.. $ Electronic Data Processing $
IF AN AMOUNT IS SHOWN AFTER A SPECIFIC COVERAGE, THAT AMOUNT WILL BE IN ADDITION TO THE
VALUE PROTECTION GROUP AGGREGATE AMOUNT FOR THAT SPECIFIC COVERAGE.
LIABILITY AND RELATED COVERAGES
LIMIT OF LIABILITY
Bodily Injury, Property Damage,
Personal Injury, and Advertising Injury $ 1,000,000 Per Occurrence
Products-Completed Operations Hazard $ 2,000,000 Aggregate Limit
Premises Medical Coverage $ 5,000 Each Person/$25,000 Each Occurrence
Fire Legal Liability - Real Property S 50,000 Each Occurrence
Telephone Directory Liability $ 1,000,000 Aggregate Limit
AUTO COVERAGES
I. Auto Liability LIMIT OF LIABILITY
Bodily Injury and Property Damage S 1,000,000 Each Occurrence
Uninsured/Underinsured Motorist $ 1,000,000 Each Occurrence
Auto Medical Payments $ 2,000 Each Occurrence
II. Auto Physical Damage
Comprehensive Actual cash value less $250 Deductible
Collision Actual cash value less $500 Deductible
CRIME COVERAGES
$ 40,000 Limit of liability per occurrence applies to the combined crime coverages below:
Employee Dishonesty CRIME DEDUCTIBLES
Forgery or Alteration $500 Deductible per Occurrence
Theft, Disappearance, 8 Destruction
Robbery and Safe Burglary
POLICY FORMS/ENDORSEMENTS ATTACHED AT INCEPTION: RP-101(5/88), RP-116(5/88), RP-120(8/93), RP-207(10/96),
SP-472(9/98), SP-473(9/98), RP-193(4/96), RP-208(10/96), RP-102(8/93), RP-104(5/88), RP-154(5/88),
RP-121(4/95), RP-112(5/88), CA2203(10/97), CA2150(9/98), SPEC END-1.
AUTHORIZED SIGNATURE DATE
FORM RP-100(5/88)
9 90028'
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