HomeMy WebLinkAbout980254.tiff AID//ItII® CERTIFICATE OF INSURANCE DATE(IA M/DD/YY)
01/28/98
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins . Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. O. BOX 578 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
ATravelers Insurance ,y
INSURED -_COMPANY _ _--
Weld Adolescent Resources
Jesse Quinby dba BColorado Comp ensati Authority
co
2116 24th Street CANY - r, .,J
Greeley, CO 80631 51 m -
COMPANY TJ 7.T7
COVERAGES ! .,; -
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR E POLICY-PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEGF TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOZALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(Al M/DD/W) DATE(MM/DO/W)
A GENERAL LIABILITY I660382R536ATIL98 02/01/98 02/01/99 GENERALAGGREGATE s2 , 000 , 000
X COMMERCIAL GENERAL LIABILITY I PRODUCTS-COMP/OPAGG s2 , 000 , 000
CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $1, 000 , 00O
OWNER'S&CONTRACTOR'S PROT I EACH OCCURRENCE $1, 000 , 000
.. . . ........ . -.-.-._-._ FIRE DAMAGE(Any one fire)$501000
'.,MED EXP(Any one person) $5, 000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
�� SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
J'. NON-OWNED AUTOS (Per accident)
- - - - ------ PROPERTY DAMAGE $
GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY
EACH ACCIDENT IS
AGGREGATE IS
EXCESS LIABILITY '.. I EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM', $
B WORKERS COMPENSATION AND 13121780 07/01/97 07/01/98 STATUTORY LIMITS
EMPLOYERS LIABILITY IEACH ACCIDENT $100 ,000 -.
THE PROPRIETOR/ � I ---
INCL DISEASE-POLICY LIMIT 600, 000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL DISEASE EACH EMPLOYEE $100, 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Weld County EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
915 10th Street 1 O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Greeley, CO 80631 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHOR 'I1EP ESENTATIVE
ACORo2s•s(3/93)1 oil #8100823/M10.0821 DJG o
980254
Sd 1# 24/9
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