HomeMy WebLinkAbout972215.tiffCertificate of Insurance
IIS (LRI IFICA I I IS KS'. I I) AS A NIX] I FR OF INFORAIA1ION ONLY ANDCONFERS NO KR .1 ITS Ill'ON YOU I I Ili CI.RTII ICAI I-. I IOI DG.IL THIS C FRTIII( AT All, IS NOI
\N INSURANCE POLICY AND DOLS ROT AMI NI) LXTEND OR AI TI.R THI (OA LRACL AIOROTD 13Y Ills 1'01 ICIES I. IST1,1) 111.19W.
This is to Certify that
HENKELS & McCOY, INC.
985 JOLLY ROAD
BLUE BELL, PA 19422
D2
1
Name and
- address of
Insured.
LIBERTY
MUTUAL,.
Is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their
terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be
issued.
EXP. DATE
❑ CONTINUOUS
TYPE OF POLICY O EXTENDED
® POLICY TERM
WORKERS
COMPENSATION
10/1/98
POLICY NUMBER
WC2-631-004085-027
GENERAL
LIABILITY
® OCCURRENCE
O CLAIMS MADE
AUTOMOBILE
LIABILITY
OWNED
NON -OWNED
HIRED
10/1/98
RETRO DATE
RG2-631 -004085-067
10/1/98
OTHER
AS2-631-004085-047
LIMIT OF LIABILITY
COVERAGE AFFORDED UNDER WC
LAW OF THE FOLLOWING STATES:
ALL STATES EXCEPT STATE
FUND STATES
EMPLOYERS LIABILITY
Bodily Injury By Accident
$1,000,000 Each
Accident
Bodily Injury By Disease
$1,000,000 Policy
Limit
Bodily Injury By Disease
$1,000,000
General Aggregate - Other than Products/Completed Operations
$4,000,000
Products/Completed Operations Aggregate
$4,000,000
Bodily Injury and Property Damage Liability
$2,000,000
Each
Person
Personal Injury
$2,000,000
Other INCLUDES'. PRODUCTSCOMPLErED
OPERATIONS. INDEPENDENT
CONTRACTORS.
$2,000,000
Per
Occurrence
Per Person/
Organization
Other ALSO INCLUDES
CONTRACTUAL LIABILITY
AND CU
Each Accident - Single Limit
B.I. and P.D. Combined
Each Person
Each Accident or Occurrence
Each Accident or Occurrence
7
ADDITIONAL COMMENTS
ALL OPERATIONS PERFORMED BY THE NAMED INSURED
If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date.
SPECIAL NOTICE -OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS
AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE
THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED
UNDER THE ABOVE POLICIES UNTIL AT LEAST 3D DAYS
NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO:
CERTIFICATE
HOLDER
WELD COUNTY
P 0 BOX 758
GREELEY CO 80632
BOWS -frit
i//
Iv,r,ulo,Ihc LEH It 1 AIt: IL Al II'(L 1' a•uya-t
3001
Liberty Mutual Group
H. Gail H
AUTHORIZED REPRESENTATIVE
Wayne, PA (610) 971-9394
OFFICE PHO
liorJ, I,)
10/01/97
972215
FLORIDA
IMPORTANT NOTICE TO POLICYHOLDERS AND CERTIFICATE HOLDERS
In the event you have any questions or need information about this certificate for any reason, please
contact your local Sales Producer whose name and telephone number appears on the front lower right
hand corner of this certificate. The appropriate local Sales Office mailing address may also be obtained
by calling this number.
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