HomeMy WebLinkAbout961887.tiff CSR ISSUE DATE(MM;UD/YY)
ACORD CERTIFICATE OF INSURANCE
09/24/96
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INF0RI LYTIDN ONLPttND
ALEXANDER & ALEXANDER CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.TATS CERTIFICATE
OF TEXAS, INC. DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
2711 N. Haskell Ave. LB 8 POLICIES BELOW.
DALLAS, TX _
75204
COMPANIES AFFORDING COVERAGE
Brock D. Duckworth
214-989-0000 COMPANY '
LETTER A NATIONAL SURETY CORPORATION 1�
COMPANY B AMERICAN INSURANCE COMPANY
INSURED LETTER
TECOM INCORPORATED
5608 PARKCREST DRIVE COMPANY C TIG INSURANCE COMPANY
SUITE 200 LETTER
AUSTIN, TX
78731 COMPANY
LETTER
COMPANY v
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 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LTR
DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS
GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000
A X COMMERCIALGENERALLIABILITY KXC80495481 10/01/96 10/01/97 PRODUCTS-COMP/OPAGG. $ 2,000,000
CLAIMS MADE )( OCCUR. PERSONAL&ADV INJURY $ 1,000,000
OWNER'S&CONTRACTOR'SPROT. EACHOCCURRENCE $ 1,000,000
A X loci Pesticide FIRE DAMAGE(Any one Ere) $ 50,000
Applicators Cover MED.EXPENSE(Any one person) $ 5,000
AUTOMOBILE LIABILITY COMBINED SINGLE
A X ANY AUTO KXA80164267 TX 10/01/96 10/01/97 LIMIT $ 1,000,000
A ALL OWNED AUTOS KXC80349548 0\S 10/01/96 10/01/97 BODILY INJURY
(Per person)
SCHEDULED AUTOS $
HIRED AUTOS
- - BODILY INJURY
NON-OWNED AUTOS (Per accident) '$
GARAGE LIABILITY
PROPERTY DAMAGE
EXCESS LIABILITY EACH OCCURRENCE $ 10,000,000
C X UMBRELLAFORM XLB9291062 10/01/96 10/01/97 AGGREGATE $ 10,000,000
OTHER THAN UMBRELLA FORM
B WORKER'S COMPENSATION KWC80718548 10/01/96 10/01/97 X STATUTORYLIMITS
AND EACH ACCIDENT $ 500,000
EMPLOYERS'LIABILITY (TX & 0/S) DISEASE—POLICY LIMIT $ 1,000,000
DISEASE—EACHEMPLOYEE $ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
SEE ATTACHMENT.
CERTFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO T
WELD COUNTY LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR CO
917 TENTH ST. `, LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVE W
GREELEY, CO 80631 (O
AUTHORIZED REPRESENTATIVE
7.
lCl T /(l S` Brock D. Duckworth �"r.'�^= Bv a �_rtlw0-7✓L+'G
ACORD 25-S(7/90). ACORDCORPORATIC
ACORD CERTIFICATE OF INSURANCE CSR ISSUE DATE(MM DD YY)
09/25/96
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
ALEXANDER & ALEXANDER CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
OF TEXAS, INC. DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
2711 N. Haskell Ave. LB 8 POLICIES BELOW.
DALLAS, TX
75204 COMPANIES AFFORDING COVERAGE
Brock D. Duckworth
214-989-0000 COMPANY A NATIONAL SURETY CORPORATION
LETTER
COMPANY B AMERICAN INSURANCE COMPANY
INSURED LETTER -
TELOM INCORPORATED
5608 PARKCREST DRIVE COMPANY C TIG INSURANCE COMPANY 1 �
SUITE 200 LETTER
AUSTIN, TX COMPANY D
78731 EITER
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 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MM/DD/YY) DATE(MM/DD/YY) .
GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000
A X COMMERCIALGENERALLIABILITY KXC80349548 10/01/96 10/01/97 PRODUCTS-COMP/OP AGG. $ 2,000,000
CLAIMS MADE X OCCUR. PERSONAL&ADV.INJURY $ 1,000,000
OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ 1,000,000
A X IDcI Pesticide FIRE DAMAGE(Any one fire) $ 50,000
Applicators Cover MED EXPENSE(Any one person) $ 5,000
AUTOMOBILE LIABILITY
COMBINED SINGLE $ 1,000,000
A X AU: ANY TO KXA80164267 TX 10/01/96 10/01/97 LIMIT
A ALL OWNED AUTOS KXC80349548 0\S 10/01/96 10/01/97 BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS
BODILY INJURY
NON-OWNED AUTOS (Per amden0
GARAGE LIABILITY
PROPERTY DAMAGE $
EXCESS LIABILITY EACH OCCURRENCE $ 10,000,000
C X UMBRELLAFORM XLB9291062 10/01/96 10/01/97 AGGREGATE $ 10,000,000
OTHER THAN UMBRELLA FORM
B WORKER'S COMPENSATION KWC80718548 10/01/96 10/01/97 X SI'ATUtORY LIMITS.
AND EACH ACCIDENT $ 500,000
DISEASE—POLICY LIMIT $ 1,000,000
EMPLOYERS'LIABILITY (TX & O/S) -- -- -- - - -
DISEASE—EACH EMPLOYEE I$ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
SEE ATTACHMENT.
CERTFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
WELD COUNTY LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
917 TENTH ST. LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
GREELEY, CO 80631
AUTHORIZED REPRESENTATIVE Art"
Brock D. Duckworth Anveee-
ACORD 25-S(7/90?. _ _ ACORD CORPORATION 1990
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