HomeMy WebLinkAbout982334.tiff CERTIFICATE OF INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIGA a CONFERS NO RIGHTS
UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE I Ey '� `� POLICY AND
DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AR g •LI IES LISTED BELOW.
I "SRS
J/r A Stock Company This is to Certify that ORGAN COUNTY REA C
1/ V�le�ra'ry)IpJ/(ecl (Name
insured)aaarea FORT MORGAN ' ^C0 k0�� �'(i J4
I� Is,at the issue date of thscedlbcate,insured by the company under the ootcy(ten listedb ft e afforded by the listed
oaor sther docusubject
ent with respe to ail ct r to rfilch IIIsscenlnc.ande may beissus andes.
not ane,e Af tl{Eur BOARD
O tor R condition of any contract
11875 W. 85th Street P.O Box 15147 Lenexa, KS 66285-5147 (913)541-0150 (800)3516-8360 Facsimile(913)541-9004
POLICY Limits of Liability in Thousands(000's)
POLICY EXPIRATION EACH
TYPE OF INSURANCE NUMBER DATE OCCURRENCE AGGREGATE
GENERAL LIABILITY
[X]COMPREHENSIVE FORM
[XJ PREMISES-OPERATIONS
[XJ EXPLOSION AND COLLAPSE
HAZARD BODILY INJURY AND $2,000 N/A
[XJ UNDERGROUND HAZARD 05 ARB 020-99 1-01-02 PROPERTY DAMAGE
[X]PRODUCTS/COMPLETED COMBINED
OPERATIONS HAZARD
[X]CONTRACTUAL INSURANCE
[XJ BROAD FORM PROPERTY
DAMAGE
[XJ INDEPENDENT CONTRACTORS
[X]PERSONAL INJURY
AUTOMOBILE LIABILITY
[X]COMPREHENSIVE FORM BODILY INJURY AND $2,000 N/A
[X]OWNED 05 ARB 020-99 1-01-02 PROPERTY DAMAGE
[X]HIRED COMBINED
[XJ NON-OWNED -
EXCESS LIABILITY INCLUDING BODILY INJURY AND
AUTO&GENERAL PROPERTY DAMAGE N/A N/A
[X]UMBRELLA FORM COMBINED
WORKERS'COMPENSATION
and 05 WC 020-99 01/01/2000 STATUTORY $500 (Each Accident)
EMPLOYER'S LIABILITY $500 (Disease-Policy Limit)
$500 (Disease-Each Employee)
Deductibles Property Limit
[X]ALL RISK PROPERTY INCLUDING 05 ARB 020-99 1-01-02 $500 Property
PHYSICAL DAMAGE ON VEHICLES $500 Comp
$500 Collision
DESCRIPTION OF OPERATIONS
DATE ISSUED: 11/06/1998 'cANCELLAT1oN:
NAME AND ADDRESS OF CERTIFICATE HOLDER ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
rr BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY
WELD COUNTY% BD. OF COUNTY COMM. i::? WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
rt:f* CERTIFICATE HOLDER BUT FAILURE TO MAIL SUCH NOTICE SHALL
915 10TH ST. IMPOSE NO OBLI N OR LIABILITY OF ANY KIND UPON THE
GREELEY, CO 80631 SOR REPRESEN ATVES. �� ^
AUTHORIZED REPRESENTATIVE
O A D :LG: EG 982334
FED-100(4-92)
-IA/5&14,
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