HomeMy WebLinkAbout962384.tiff .+ /:IIRII CERTIFICATE OF INSURANCE DATE(MMIDENTY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins . Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. BOX 578 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W. 18th Street COMPANIES AFFORDING COVERAOr
Greeley, CO 80632 COMPANY
AThe Travelers Indemnity/Aetna "Casual
INSURED COMPANY
Weld Adolescent Resources BColorado Compensation lutIorit
Jesse Quinby dba COMPANY
2116 24th Street C
Greeley, CO 80631 COMPANY
D
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCV 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.
POLICY EFFECTIVE POLICY EXPIRATION
CO TYPE OF INSURANCE POLICY NUMBER LIMITS
LTR DATE(MM/DD/TY) DATE(NM/DD/TY)
A GENERAL LIABILITY ACM25828252 02/01/97 02/01/98 GENERAL AGGREGATE $2, 000, 000
X OMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OPAGG $2 , 000 , 000
CLAIMS MADE XJ OCCUR PERSONAL&ADV INJURY $1, 000, 000
' OWNER'S&CONTRACTOR'SPROT EACH OCCURRENCE $1, 000, 000
FIRE DAMAGE(Any one lire)$50, 000
MED EXP(Any one person) $5, 000
AUTOMOBILE LIABILITY
COMBINEDSINGLELIMIT $
' ANY AUTO -
ALLOWNEDAUTOS BODILY INJURY $
_ (Per person)
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY $
(Per accident)
NON-OWNED AUTOS
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
B WORKERS COMPENSATION AND 3121780 07/01/96 07/01/97 JSTATUTORYLIMITS
EMPLOYERS'LIABILITY [EACH ACCIDENT _$100 , 000
THE PROPRIETOR/ INCL DISEASE-POLICY LIMIT $500 , 000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $100, 000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONS/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 1.0_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 U N THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORI SENTATIVE
cci
ACORD25•S(3re3)1 Oil #576323/M76321 JG QACOR.:DCORF
962384
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