HomeMy WebLinkAbout991476.tiff Client# : 12170 GRECI
_ DATE(MMIDD/YV)
ACORDN CERTIFICATE OF LIABILITY INSURANCE 06/07/99
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood and Peterson Insurance, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.
P. O. Box 578
ALTER THIS
THE COVERAGE NOT
AFFORDED BY THE POLICIES BELOW.
4687 W. 18th Street INSURERS AFFORDING COVERAGE
Greeley, CO 80632
INSURED INSURERA:TIG Insurance Company _.
City Of Greeley INSURER B: --
dba Rocky Mountain Senior Games �FINSURERc: --
1010 Sixth Street II NSURERD:
Greeley, CO 80631 rNsuRERE:
COVERAGES THE POUCIES OF INU D INDICATED.ANY REQUIREMENTS TERM BELOW
INSURED NAMED PERI
CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFCATE MAY BE ISSUED
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS
1 POLICY EFFECTIVE POLICY EXPIRATION
TM TYPEOFINSURANCE POLICY NUMBER DATE(MM/DDIYYI DATE(MM/DDIYY)
A GENERAL LIABILITY 01T70003739386103 06/01/99 . 06/01/00 LkElkCH FREDAMAGRENCEAny nreji$30000,000-
Xi GENERAL LIABILITY
MED EXP(Any one person) I$5, 000
_I CLAIMS MADEXOCCUR PERSONAL&ADV INJURY $1.`000000-
GENERAL AGGREGATE $NOne
PRODUCTS-COMPIOPAGG $1, 000 000
GEM
POLICY GATE LIMIT APPLIES PER: I **.* (500 , 000
POLICY PIFST � LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
kAUTOMOBILE accident) Imo$
ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
(Per person)
SCHEDULED AUTOS
BODILY INJURY $
HIRED AUTOS (Per accitlent)
NON-OWNED AUTOS
— PROPERTY DAMAGE �$
(Per accident)
LAUTO ONLY-EA ACCIDEN $ _
GARAGE LIABILITY OTHER THAN EA ACC I$
1 ANY AUTO AUTO ONLY: AGO I$
EACH OCCURRENCE I$
EXCESS LIABILITY AGGREGATE 'S
HOCCUR CLAIMS MADE $
DEDUCTIBLE $
RETENTION $ WC STATU- OTH-
�flYTITTS1llO
WORKERS COMPENSATION AND E.L.EACH ACCIDENT i$
EMPLO'iETS'!(ABILITY
E.L.DISEASE-EAEMPLOVE $ --E.L.DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
*** Participant Legal Liability
The certificate holder is an additional insured per Form CG 2011 - Lessors
or Managers or Premises but only with respects to the operations of the
insured.
CERTIFICATE HOLDER ADDmONAL INSURED;INSUPERLETrER _ CANCELLATION
SHOULD ANYOFTHE ABOVE DESCRIBEDPOUCESB CA CELLED BEFORETHE EWIIRATION
Weld County Colorado By & DATETHEREOF,THE ISSUING INSURER WILL END AV^RTOMAIL1-U-DAYSWRRTEN
through the Board of County NOTICETOTHE CERTIFICA HOL NAMEDTOTH LE ,BLIIFAILURE TO DOSOSHALL
Commissioners of Weld County, IM NO OBLIGATION RLIABILI FANYKIN U •N THEINSIr AGENTS OR
The Weld County Sheriff & their REPRES TATI S.
IgUTHORI2 IVE
employees 1
915 -1.0th St . , Greel.ev, CO 80611. DSM
ACORD25-s(7/97)1 of 2 *5130652/M130648 - 991476
hG �� z. / 97 /PI52CJUK
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD25-S(7M7)2 of 2 #S130652/M130648
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