HomeMy WebLinkAbout970502.tiffCERTIFICATE OF INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND
DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW,. -
A Stock Company
Iedera lid.
ofge
miga
This is to Certify that I— MORGAN COUNTY REA
(Name and address 20169 HWY. 34
of insured) I FORT MORGAN
CO 80701-
ps. at the issue date of certificate. insured by the Company under the pnilcylies) listed below. The Insurance artordfd by the listed'
olicyfiea) is subject to at their Iems, exclusions and conditions and is not altered by any requirements, ter, or condition of any centrist
or other docanert with respect to which this certificate may he issued.
11875 W. 85th Street P.O Box 15147 Lenexa, KS 66285-5147 (913)541-0150
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION
DATE
(800)356-8360 Facsimile (913)5¢1-9004
Limits of Liability in Thousands (000'51
EACH
OCCURRENCE AGGREGATE
GENERAL LIABILITY
[X] COMPREHENSIVE FORM
[X] PREMISES - OPERATIONS
[X] EXPLOSION AND COLLAPSE
HAZARD
[X] UNDERGROUND HAZARD
[X] PRODUCTS/COMPLETED
OPERATIONS HAZARD
[X] CONTRACTUAL INSURANCE
[X] BROAD FORM PROPERTY
DAMAGE
[X] INDEPENDENT CONTRACTORS
[X] PERSONAL INJURY
05 ARB 020-97
1/1/99
BODILY INJURY AND
PROPERY DAMAGE
COMBINED
$2,000
AUTOMOBILE LIABILITY
[X] COMPREHENSIVE FORM
[X] OWNED
[X] HIRED
00 NON -OWNED
EXCESS LIABILITY INCLUDING
AUTO & GENERAL
p9 UMBRELLA FORM
WORKERS' COMPENSATION
and
EMPLOYER'S LIABILITY
05 ARB 020-97
05 WC 020-97
1/1/99
1/1/90
[X] ALL RISK PROPERTY INCL.
PHYS. DAMAGE ON VEHICLES
05 ARB 020-97
1/1/99
BODILY INJURY AND
PROPERY DAMAGE
COMBINED
BODILY INJURY AND
PROPERY DAMAGE
COMBINED
iiiiiiiiiiiiiSTATUTORY
$2,000
$500 (Each Accident)
$500 (Disease - Policy Limit)
$500 (Disease - Each Employee)
$500 Ded. amprehensive
$500 Ded.CbLlisirn'l
All Risk Blanket
DESCRIPTION OF OPERATIONS
INNESUMMEREMMISge
DATE ISSUED: 01/31/1997
NAME AND ADDRESS OF CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY
Mil WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER, BUT FAILURE TO MAIL SUCH NOTICE SHALL
IMPOSE NOO LIGATION OR LIABILITY OF ANY KIND UPON THE
ii COMPANY, I$ AGENTS OR REPRESENTATIVES.
$500 Ded Property
$11,864,723 Limit
Weld County % Board of County Commissioners
915 10th Street
Greely, CO 80631
ci
AUTHORIZED REPRESENTATIVE
FED -100 (4-92)
970502
Hello