HomeMy WebLinkAbout981348.tiff A'/'/'1'/®: CERTIFICATE OF I UI AN tie 06547 ! ISSUE DATE (MM/DD/YY)
PRODUCER \ :-- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
.` CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
Moody Insurance Agency DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
Phone (303) 824-6600 POLICIES BELOW.
Fax (303) 370-0118 Y .- ' `' '" -7.Y,7-7
_ - COMPANIES AFFORDING COVERAGE
3773 Cherry Crk No #800
Denver CO 80209-3804 -.L F:!--; s COMPANY A Colorado Compensation Insurance
.. - LETTER
}
COMPANY B
INSURED LETTER
uality Resurfacing Co. COMPANY C
5231 E 78th Avenue LETTER
Commerce City CO 80022 COMPANY D
LETTER
COMPANY E
LETTER
;: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 CONDITIONS OFISUCH POLIVCIEs.LIMITS SHOWAFFORDED
MAYDHAVE BEEN POLICIES DESCRIBED
Y PAID CLAIMSEIN IS SUBJECT TO ALL THE TERMS,
:O POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE POLICY NUMBER LIMITS
_TR DATE (MM/DD/YY) DATE (MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $
bOMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $
bLAIMS MADE I OCCUR. PERSONAL&ADV.INJURY $
OWNERS&CONTRACTOR'S PROT. EACH OCCURRENCE $
FIRE DAMAGE(Any one fire) $
MED.EXP.(Any one person) $
AUTOMOBILE LIABILITY COMBINED SINGLE
ANY AUTO LIMIT $
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident) $
GARAGE LIABILITY
PROPERTY DAMAGE
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
A 2288480 07/01/98 07/01/99 xi STATUTORY LIMITS
WORKER'S COMPENSATION
EACH ACCIDENT $ 100, 000
AND
DISEASE-POLICY LIMIT $ 500, 000
EMPLOYERS'LIABILITY
DISEASE-EACH EMPLOYEE $ 100 , 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Re: Weld County 1998 Slurry Seal Project
Policy contains a Waiver of Subrogation in favor of Certificate Holder
CEATIF'#CATE.MOLDER CAICELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO
Weld County Colorado MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Director of General Svcs LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 4k01.\-? P.O. Box 758
4,\Olj :H. LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
Nk, ,,AGreeley CO 80632 ;> AUTHORIZED REP NTATIVE
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