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Of ® CERTIFICATE OF INSURANCE ISSUE D TE(MM'DD"Y)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,
P?.NCO EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Bnl 305'07
COMPANIES AFFORDING COVERAGE
Nashville, TN 37230-5:07
COMPANY A ,._,-''F ELD '3S7'C.C£ ^OYPANY
LETTER
COMPANY 7
LETTER s
INSURE , 71
pp P,t 9olorado 1 eryovernmental 7 C
Risk Sharing Agency (CIRSAI COMPANY (—
LETTER C U. J
950 South Cherry Street, #800 i_) II CJ
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Denver, r0 80222 COMPANY D -- c'�
LETTER '-. �w:
TEL: 1303) 757-5475 FAX: (303) 757-8950 Ip��� :Ii
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TOWN OF EERSEY COMPANY �.../ CA _cI
LETTER E ',.' '. _ ,
C=^7
COVERAGES
THIS IS TO CERTIFY THAT 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 CONDI-
TIONS OF SUCH POLICIES.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
LTR DATE IMM/D0NY) DATE(MWD0/YY) EACH AGGREGATE
OCCURRENCE
O NFf AL LIABILITY AAO1136 01/01/2000 01/01/2001 BODILY
COMPREHENSIVE FORM INJURY $ $
PREMISES/OPERATIONS PROPERTY
UNDERGROUND DAMAGE $ $
iiEXPLOSION 8 COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS + R
CONTRACTUAL COMBINED $
INDEPENDENT CONTRACTORS Ell 8 PD BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY PERSONAL INJURY $
A T9MOBILE LIABILITY AA01'35 01/0112000 01/01/2001 su°Dow 'r
ANY AUTO (PEA RAS0NI $ +' r'
ALL OWNED AUTOS(PRIV. PASS.) BWLY �„ s C.
ALL OWNED AUTOS(PRN RPTHAN) WWY
(PEA ACCIDENT) $ x. yr+ 4=
g'
HIRED AUTOS PROPERTY
0."s 4*^` "w
NON-OWNED AUTOS DAMAGE $ '_`m";=Q°`
GARAGE LIABILITY *,,A T'A b
BI 8 PD %:... Y Y
COMBINED $
EXCESS LIABILITY
UMBRELLA FORM BI a PD $ $
COMBINED $ $
OTHER THAN UMBRELLA FORM
STATUTORY r': ' +' '
WORKERS'COMPENSATION 'aa '
w,YC,'" $ (EACH ACCIDENT)
AND 4.4
4%44: $ (DISEASE-POLICY LIMIT)
EMPLOYERS' LIABILITY ;C.:
.:$ (DISEASE-EACH EMPLOYEE)
OTHER
DESCRIPTION.D€OPeR scheanie roil [ovveVrage aaU CarneCSTEms
As respects law enforcement agreement covering activities of
Town's 'olice while 'erformin' traffic enforcement on Kerse Portion.
CERTIFICATE HOLDER CANCELLATION
Additonal Insured: Certificate No: 3854 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
WELD COUNTY COMMISSIONERS PIRATI®N DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
D O 758 MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT,BUT FAILURE TO MAR SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
CRERLEY, CO 80632 OF ANY KIND UPON T COMPANY, ITS . ti OR REPRESE ATIVES.
AUTHORIZED REPRES- ' TIVE
Attn: Dale Hall 2L,. ' / - diEaril-
Iv
ACORD 25 18)84, IIRI
992727
COLORADO PROPERTY/CASUALTY
INTERGOVERNMENTAL
RISK SHARING AGENCY
DESCRIPTION OF COVERAGE
* to $150K per person/$600K per occurrence for liability claims subject to
Governmental Immunity Act; $1.5M claim/occurrence other automobile
claims; $5M claim/occurrence other liability claims; $10TVI per member
aggregate on public officials liability. All coverages subject to aggregate
and other limits.
L L L L L
SCHEDULE OF EXCESS LIABILITY CARRIERS
2000
$4,000,000 EXCESS OF $1,000,000
NORTHFIELD INSURANCE COMPANY
POLICY NUMBER AA01136
2000 ceillhab bath
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