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ACORDTM CERTIFICATE`.OF INSURANCE oa%isi99
PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Van Gilder Insurance Corp. -S''i'R _ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
214 South 3rd Street _. . _ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sterling, CO 80751 COMPANIES AFFORDING COVERAGE
I COMPANY
ASt . Paul Insurance Companies
INSURED --' COMPANY
K & K Roustabout SerifrsCe B
P .O. Box 529
COMPANY
Sterling„ CO 80751
COMPANY
D
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO IPOLICY EFFECTIVE POLICY EXPIRATION
L TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MM/DD/YY) LIMITS
A GENERAL LIABILITY VKO8300600 1 08/28/99 08/28/00 I GENERAL AGGREGATE $2 , 000 , 000.
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $2 , 0 0 0, 0 0 0
CLAIMS MADE I X OCCUR PERSONAL&ADV INJURY $1 LOO, 0.0 0
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE SI 000, 000
FIRE DAMAGE(Any one fire) $100, 000
I MED EXP(Any one person) 6, 000
A AUTOMOBILE LIABILITY VKO8300600 08/28/99 08/28/00 COMBINED SINGLE LIMIT $1 0 0 0 , 0 0 0
- _- ANY AUTO
ALL OWNED AUTOS BODILY INJURY
(Per person)
X SCHEDULED AUTOS
X HIRED AUTOS BODILY INJURY
(Per sodden))X NON OWNEDAUTOS I$
----------- - PROPERTY DAMAGE '.5
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
—I ANY AUTO OTHER THAN AUTO ONLY
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE '$
IUMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND I I. 1 STATUTORY LIMITS
EMPLOYERS'LIABILITY EACH ACCIDENT $
THE PROPRIETOR/ INCL ' DISEASE-POLICY LIMIT $
PARTNERS/EXECUTIVE --- -----OFFICERS ARE EXCL DISEASE-EACH EMPLOYEE $
A OTHER VKO8300600 08/28/99108/28/00Limit : $134 , 500 .
Contractor Equip .
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/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
P .O. Box 758 1 Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Greeley, CO 80632 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTNORIZEL11EE*RESENTAR1rE yy 4
ACORD2SS(3Ba)1 of 1 M65803 992159
ConSernf agend f?-45-9r1
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