HomeMy WebLinkAbout972787.tiffAI:Illtll®
CERTIFICATE
OF
INSURANCE
12/`22/97
PRODUCER
Flood & Peterson Ins. Inc.
P. O. BOX 578
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W. 18th Street
COMPANIES AFFORDING COVERAGE
Greeley, CO 80632
COMPANY
ACNA Insurance Company a
INSURED
Best -Way Paving Company
/ I
COMPANY `. 1 C J 0
BCrum & Forster i(_' n 7
131 N. 35th Avenue
P. O. Box 3189
. I")
COMPANY _
C
Greeley, CO 80633
7
COMPANY -• '�
DI
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 CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MM/DD/r0
POLICY EXPIRATION
DATE(MM/OD/YY)
LIMITS
A
GENERAL LIABILITY
01043645823
01/01/98
01/01/99
GENERAL AGGREGATE
$2, 000, 000_
X
COMMERCIAL GENERAL LIABILITY
PRODUCTS -COMP/OP AGG
$2 , 000, 000
CLAIMS MADE
XII OCCUR
PERSONAL Si ADV INJURY
$1 , 000, 000
II
OWNER'S BCONTRACTOR 'SPROT
EACH OCCURRENCE
$1, 000, 000
AFIRE DAMAGE (Any one tire)
$50,000
MED EXP (Any one person)
5,000
A
AUTOMOBILE
X
LIABILITY �...
ANY AUTO
C1056451794
01/01/98
01/01/99
COMBINED SINGLE LIMIT
$1,000,000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person) I
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Par accident)
PROPERTY DAMAGE
$
GARAGE
LIABILITY
AUTO ONLY -EA ACCIDENT
ANY AUTO
OTHER THAN AUTO ONLY
EACH ACCIDENT
$
AGGREGATE
$
B
EXCESS LIABILITY
5530456836
01/01/98
01/01/99
EACH OCCURRENCE
B2,000,000
X UMBRELLA FORM
AGGREGATE
i2, 000, 000
OTHER THAN UMBRELLA FORM
$
A
WORKERS COMPENSATION AND
C1056451813
01/01/98
01/01/99
X
STATUTORY L IMITS
EMPLOYERS' LIABILITY
EACH ACCIDENT
$100,000
THE PROPRIETOR/ I
INCL
DISEASE -POLICY LIMIT
$500,000
PARTNERS/EXECUTIVE
OFFICERS ARE:
EXCL,
DISEASE -EACH EMPLOYEE $100, 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
RE: 1997 Chip and Seal Project
Weld County, Colorado is named as Additional Insured.
CERTIFICATE HOLDER
Weld County, Colorado
915 10th Street
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE OANC LED BEFORE THE
EXPIRATION DATE THEREOF UING COMPANY WILL E D A OR •MAIL
10 DAYS WRITTEN TICE TO THE CE IFICATEHOLDE N EDT•THE LEFT,
Greeley, CO 80631
B AI LURE TO MAILS CH NOTICE SHALL POSE NOOK
OF A KIND ON T COMPANY, ITS AGENTS OR
TI.NO- LIABILITY
PRA SE ATIVES.
AyTHORI D RE ESENTA /
I
ACORD 15.S(3/S3)1 of 1 # S98319 M98224
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