HomeMy WebLinkAbout992911.tiff ACORD CERTIFICATE OF LIABILITY INUTANCE 12/Dl/1999
PRODUCER (303)824-6600 FAX (303)370-0118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Moody Insurance Agency, Inc. , ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
3773 Cherry Creek North Drive . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sui to 800 COMPANIES AFFORDING COVERAGE
Denver, CO 80209-3804 COMPANY Travelers Indem Co of America
Attn: Tammy L.Engler Ext: 16835 A
INSURED COMPANY Travelers Indem Co of Ill
Quality Resurfacing Company. _ _. B
5231 E 78th Avenue i- I Travelers Property & Casualty
Commerce City, CO 80022 COMPANY
COMPANY Pinnacol Assurance Company
D
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 POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR TYPE OF INSURANCE DATE(MM/DDIYY) DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ 2,000,000
CLAIMS MADE X OCCUR PERSONAL 8 ADV INJURY $ 1,000,000
A DTCO754G6115 12/01/1999 12/01/2000
EACH $ 1,000,000
OWNER'S&CONTRACTOR'S PROT R -
X Per Proj Aggregate FIRE DAMAGE(Any one ere) $ 100,000
X Blnkt Addl Insrd MED EXP(Any one parson) $ 5,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
X ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
(Per Person)
B SCHEDULED AUTOS DT-81075466115 12/01/1999 12/01/2000 e
X HIRED AUTOS BODILY INJURY $
(Per accident)
X NON-OWNED AUTOS
X $100 Comp Deduct PROPERTY DAMAGE $
X $250 Coll Deduct
AUTO ONLY-EA ACCIDENT $
GARAGE LIABILITY
OTHER THAN AUTO ONLY.
ANY AUTO
EACH ACCIDENT $
_ AGGREGATE $ _.. _.
EACH OCCURRENCE $ 5,000,000
EXCESS LIABILITY
C X UMBRELLA FORM CUP754G6115 12/01/1999 12/01/2000 AGGREGATE $ 5,000,000
OTHER THAN UMBRELLA FORM _ SIR $ 0
___,- X WC STATU 0TH-
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100,000
D 2288480 07/01/1999 07/01/2000 EL DISEASE-POLICY LIMIT $ 500,000
THE PROPRIETOR - INCL
PARTNERS/EXECUTIVE EL DISEASE-EA EMPLOYEE$ 100,000
OFFICERS ARE' EXCL
$4,821,005 Limit
B�Tan�cet Equipment
g Coverage QT660756G2060 12/01/1999 12/01/2000 $2, 500 Deductible
Max Item $250,000 Limit
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
411 Operations with respect to work performed by Insured on behalf of Certificate Holder
Project: 1999 Rubberized Crack Filling Project Weld County is named as an Additional Insured
Nith regard to work performed under the General Liability coverage.
GERTIPICATE HOLDER _ CANCELLATIOPI;.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Weld County Colorado
915 10th St. OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIIVEESSS.
Greeley, CO 80632 AUTHORIZED REPRESENTATIVE - y ,V7A/ /y
a /
Tammy Engler/TLE
ACORD 26-$F1NS91': SACORD CORPORATION 199$
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