HomeMy WebLinkAbout960215.tiff I Certificate of Insurance
]Ills( IBTIIIC;AI I IS IASOI'I).AS A A1AHI E o OL IAli'ltVt.A I ICA UAI 1 An/ U)AI I'In VC ItIC:I I IS LION 1CI IHL CIIIt II K \TIL I RP DER. 11118 CI RTII ICAII'IS NCI'
ANIASL1:ANCF POI.ICY:ANDDCIcNCI -AN11 NIA II NI I ND,(AN AI I I R IIII tCA'I:RACI.AFFORDED RY IWI FOLIC IFS I Kill)HI.LOW.
eY
This is to Certify that LIBERIA( Tt
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MUTU
H2O CONSTRUCTION & MAINTENANCE INC Name and
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1407 CHASE STREET I address of T C-.1 U
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LAKEWOOD CO 80214 Insured. 61 m -.3n o
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Is,at the issue date of this certificate,insured by the Company under the policy(ies)listed below. The insurance afforded by the fisted policy(ies),yL.sub{ert te-0lI their
terms,exclusions and conditions and is not altered by any requirement,term or condition of any contract or other document with respectfd which tligcerdlttAte4nay be
issued. r
EXP.DATE p,
• L CONTINUOUS '
TYPE OF POLICY G EXTENDED POLICY NUMBER LIMIT OF LIABILITY
__ _ ___ N -POLICY TERM WORKERS
COVERAGE ORDED W AFF GNTAT t 00 000 ry B Accident
! LAW FORDEDU STATES: ---
COMPENSATION 07-01-96 WC1-191-092182-015 Bodily
Each
COLORADO Accident
Bodily Injury By Disease
500,000 Policy
Limit
Bodily Injury By Disease
100,000 Each
Person__
- - p-- _.
I General Aggregate-Ocher than Products/Completed Operations
GENERAL
LIABILITY 2,000,000
Products/Completed Operations Aggregate
IXI OCCURRENCE 07-01-96 YY2-191-092182-025 1,000,000
,I CLAIMS MADE Bodily'Nun/and Property Damage Liability Per
1,000,000 Occurrence
r Personal and Advertising-injury
Per Person/
RETRO DATE _- IL 1,000,000 Other Organization• OtherJ i..
AUTOMOBILE 1,000,000 Each Accident-Single Limit
LIABILITY B.I.and P.D.Combined
• N OWNED Each Person
Each Accident or Occurrence
X' NON-OWNED I 07-01-96 AS2-191-092182-045
, IN HIRED Each Accidentor Occurrence
OTHER ' TH1-191-092182-055 $1,000.000 SINGLE LIMIT FOR PERSONAL INJURY
UMBRELLA (INCLUDING BODILY INJURY)AND PROPERTY DAMAGE
EXCESS LIABILITY 07-01-96 • I OVER UNDERLYING LIMITS.
_L_..
ADDITIONAL COMMENTS
IT IS HEREBY AGREED THAT-WELD COUNTY IS NAMED ADDITIONAL INSURED AS THIER INTEREST MAY APPEAR.
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' If the certificate expiration date is continuous or extended term,you will be notified if coverage is terminated or reduced before the certificate expiratqn date.
Liberty Mutual Group
SPECIAL NOTICE-OHIO: ANY PERSON WHO,WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER,SUBMITS
AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
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
UNDER THE ABOVE POLICIES UNTIL AT LEAST DAYS
NOTICE OF SUCHLCANCELLATION HAS BEEN MAILED TO'. a e" >4"-v' -
CEA11FICATE WELD COUNTY THERESA M. BACCA
� �HO�LD 915 10TH ST AUTHORIZED REPRESENTATIVE
(71' 960215
C GREELEY, CO 80631 ENGLEWOOD (303)799-0818
t I ,� PHONE NUMBER1L IR2
,v cerhficatr»emcuteJ 61'IIBt RTY 17 L'ILALC hOI,`['asrcye't-Ruh insur, uz(f<+riled by Those CRF�*lGIFe DATE IS3h1`L9B-
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