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ACORD,w CERTIFICATE OF INSURANCE DATE
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Van Gilder Insurance Corp. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
700 Broadway, Suite 1000 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
y, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, CO 80203 COMPANIES AFFORDING COVERAGE
COMPANY
AEmployers Mutual Casualty Co.
INSURED COMPANY
GRB Construction, Inc . BCrum & Forster Ins
P. O. Box 11337 COMPANY
Denver, CO 80211 CColorado Compensation Ins .
COMPANY
D
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(MIATO/YY) DATE(MMIDDITT)
A '.I GENERALUABIUTY 1X44230 07/01/99I07/01/00 GENERAL AGGREGATE 52 , 000, 000_
X'COMMERCIAL GENERAL LABILITY PRODUCTS-COMP/OP AGG $2, 000, 000
' I
CLAIMS MADE jXJOCCUR I PERSONAL SADVINJURY IS1, 000, 000
OWNER'SB CONTRACTOR'S PROT
I EACH OCCURRENCE IS1, 000, 000
I I FIRE DAMAGE(Any one fire) S 100 , 000
�� MED EXP(Any one person) I.5 5 , 000
A ! AUTOMOBILEUABIUTY 1X44230 07/01/99 '' 07/01/00 COMBINED SINGLE LIMIT ISl, 000 , 000
X ANY AUTO I --
! ALL OWNED AUTOS BODILY INJURY is
(Per person)
SCHEDULED AUTOS
X HIRED AUTOSI BODILY INJURY S
X NON-OWNED AUTOS (Per accident)
I� ''PROPERTY DAMAGE 5
GARAGE LIABILITY I I AUTO ONLY-EA ACCIDENT S
I ANY AUTO I OTHER THAN AUTO ONLY '• —.
~i IEACH ACCIDENT IS —
AGGREGATE '!S
B EXCESSUABILITY BINDER134727 07/01/99 07/01/00 EACH OCCURRENCE IS2, 000, 000
[ X UMBRELLA FORM AGGREGATE $2 , 000, 000
OTHER THAN UMBRELLA FORM IS
C WORKERS COMPENSATION AND 10832780 07/01/99 07/01/00Ix STATUTORY LIMITS _.
I EMPLOYERS'LIABILITY EACH ACCIDENT Sl 0 0, 0 0 0
i
THE PROPRIETOR/ I INCL DISEASE-POLICY LIMIT I S5 00 , 000
I PARTNERS/EXECUTIVE I
d!
OFFICERS ARE: l I EXCL, DISEASE EACH EMPLOYE4 $100 , 000
I OTHER .7.) 'I•..^
DESCRIPTION OF OPERATIONS/LOCATORS/VEHICLES/SPECIAL ITEMS :n
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Weld County Communications EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Jack Statler .10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
P.O. Box 758 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Greeley, CO 80631 OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
AUTHO D REPRESE
NTATIVE
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