HomeMy WebLinkAbout960292.tiff Certificate of Insurance
T I IIS CLKI IIICA CI H ISSULI)As A AIA rI I.I:OI IN4)KVAAIION()NI) A V U(()NI I.RS N V RIc I{I s UPON 1011 TI Ill CI I<I11 Ih A I C I IUI UI.It. THIS CI KTII I( ATF.IS V0I
AN INSU W\NCI[POI.I(1'AND All NOI,AAII ND,I`x I I ND,OR AI III)I I ((iA I R)A(.I AI I ORI)I'.I)BYI I II POI.ICIPS I ES I1 D UELC0W.
[tits is to Certiity that
BUCKLEN EQUIPMENT COMPANY INC .`._-
804 N 25TH AVE Name and
GREELEY CO 80631 4 --- address of LIBERTY
Insured. MUTUAL:- , 1c
L J
Is,at the issue date of this certificate,insured by the Company under the policy(ies)listed below. The insurance afforded by the listed policy(ies)is subject to all their
terms,exclusions and conditions and is not altered by any requirement,term or condition of any contractor other document with respect to which this certificate may be
issued.
EXP.DATE
* ❑ CONTINUOUS
TYPE OF POLICY U EXTENDED POLICY NUMBER LIMIT OF LIABILITY
O POLICY TERM
WORKERS COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY
LAW OF THE FOLLOWING STATES:
COMPENSATION 1/1/97 WC2-591-081160-026 Bodily lniury By Accident
COLORADO 100,000 Each
Accident_
Bodily Injury By Disease
500,000 Policy
Limit
Bodily Injury By Disease
100,000 Each
_-_ Person
General Aggregate-Other than Products/Completed Operations
GENERAL
LIABILITY
Products/Completed Operations Aggregate
[J OCCURRENCE
Li CLAIMS MADE Bodily Injury and Property Damage Liability Per
Occurrence
Personal and Advertising Injury
Per Person/
RETRO DATE Organization
Other Other
AUTOMOBILE Each Accident-Single Limit
_ B.L and P.D.Combined
LIABILITY
L.I OWNED Each Person
Each Accident or Occurrence
❑ NON-OWNED
Li HIRED Each Accident or Occurrence
OTHER
ADDITIONAL COMMENTS
O `i%) _a
rl rn -CD
w -17
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' II the certificate expiration date Is continuous or extended term,you will be notified if coverage Is terminated or reduced before the certificate expiratip,Odate .3
SPECIAL NOTICE-OHIO:AN APPLICATION OR FILESNY PEFISON WHO,A CLAIM CONTAIININGN INTENT TO DEFRAUD OR KNOWING THAT HE IS AFAL$E OR DECEPTIVE STATEMENT IS GUILTY OF INSURANG A FRAUD NCE E FRAUD. AGAINST AN INSURER,Sb�MITS f)
NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE
THE STATED EXPIRATION DATE THE COMPANY WILL-NOT CANCEL OR REDUCE THE INSURANCE AFFORDED Liberty Mutual Group
UNDER THE ABOVE POLICIES UNTIL AT LEAST DAYS
NOTICE OF SUGISLANCELLATION HAS BEEN MAILED TO:
)71.
THER SA M BACCA
CERTIFICATE AUTHORIZE REPRESENTATIVE
HOWER WELD COUNTY COMMISSIONERS
GREELEY CO 80631 ENGLEWOOD (303)799-0818 1/1/96
,n -J1)4.
OFFICE PHONE NUMBER DATE ISSUED
p�`0 � k 960292
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