HomeMy WebLinkAbout993031.tiff STATE of COLORADO CERTIFICATE of INSURANCE
This certificate is issued as a matter of information only and confers no rights upon the certificate holder. It does not
ammend, extend or alter the coverage afforded below. r±1
INSURED
The State of Colorado, its departments, institutions, agendies, boards, officials, employees and authorized volunteers
(except all entities of the University of Colorado) .
INSURED (Re : certificate) SOURCES OF COVERAGE
Colorado State Univ Cov A. . . State Risk Management Office
Risk Mgt Office Cov B . . . State Risk Management Office
122 Johnson Hall Cov C. . . National Union Fire
Fort Collins, CO 80523 Cov D. . . Hartford Fire Insurance Company
Attn: Sandra Trissel All coverages are effective continuously per State law.
COVERAGES
Self-insured coverages and limits shown on this certificate are those for which the State accepts responsibility pursuant to
the Colorado Governmental Immunity, Risk. Management, and Workers' Compensation Acts. Notwithstanding any requirement, term or
condition of any document to which this certificate may be issued or may pertain, the coverage afforded herein is controlled
and limited by the above laws. Commercial coverages are subject to policy terms and conditions.
COV DESCRIPTION POLICY NUMBER LIMITS
A State Liability Fund RMSIL-0985 Combined Injury Limit per
State Law CRS 24-10-114
B State Worker Compensation RMSIW-0796 Standard Limits per
Fund Colorado Worker
Compensation Act
C Commercial Property Policy IMB4647108 $250 Million, per Policy
and State Risk Management
Act
D Employee Fidelity Blanket Bond PEBEQ3813 $100 , 000
PROPERTY LEASES This certificate does not apply to a lease agreement that does not conform strictly to the
requirements of CRS 24-30-1510 (3)e.
ADDITIONAL INSUREDS. . . The Colorado constitution prohibits including certificate holders as additional insureds.
INDEMNIFICATION and This certificate applies to such provisions only to the extent permitted by Colorado law;
HOLD HARMLESS clauses: including the Colorado Constitution, the Governmental Immunity Act, and the Risk Management Act.
CANCELLATION
Should any of the above coverage change, the insured State of Colorado will endeavor to mail notice to the certificate
holder named, but failure to mail such notice shall impose no obligation or liability of any kind upon the State.
DESCRIPTION OF OPERATIONS to which this certificate pertains:
Water sampling project on the Poudre River.
CERTIFICATE HOLDER Certificate # : 451
Weld County Issue date : 12/15/1999
915 Tenth St
PO Box 758
Greeley, CO 80632
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Attn: Frank Hempen AUTHORIZ REPRESENTATIVE
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993031
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