HomeMy WebLinkAbout990586.tiff DATE(MMIDDIYY)
ACORD CERTIFICATE OF LIABILITY INSURANCE 03/16/1999
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.
Suite 800 COMPANIES AFFORDING COVERAGE
Denver, CO 80209-3804 COMPANY Travelers Indem Co of America
Attn: Tammy Engler Ext: 6635 A
INSURED COMPANY Travelers Indem Co of ill
Quality Resurfacing Company B
5231 E 78th Avenue coMPANv Colo Comp Ins Authority
Commerce City, CO 80022
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 EFFECTIVE POLICY EXPIRATION LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YV) DATI:(MM/DDIYY)
GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000
X COMMERCIAL GENERAL LIABILITYPRODUCTS-COMP/OPAGG $ 2,000,000
CLAIMS MADE X OCCUR DTCO754G6115TIA98 12/01/1998 12/01/1999 PERSONAL&ADV INJURY $ 1,000,000
A EACH OCCURRENCE $ 1,000,000
OWNER'S&CONTRACTOR'S PROT
X per project agg. FIRE DAMAGE(An y one fire) $ 100,000
X blanket add'1 insd MED EXP(Any one person) $ 5,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
X ANY AUTO 1,000,000
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
B DT-810754G6115TIL98 12/01/1998 12/01/1999
X HIRED AUTOS BODILY INJURY $
(Per accident)
X NON OWNEDAUTOS f'-
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY.
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $ 3,000,000
A X UMBRELLA FORM DTC07S4G6115TIA98 12/01/1998 12/01/1999 AGGREGATE $ 3,000,000
OTHER THAN UMBRELLA FORM SIR $ 0
WC STATU- 0TH'
WORKERS COMPENSATION AND X TORY LIMITS ER
EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100,000
C 2288480 07/01/1998 07/01/1999 EL DISEASE POI. $ 500,000
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE EL DISEASE EAEMPLOYEE'$ 100,000
OFFICERS ARE: EXCL
OTHER
DESCRIPTION OF DPERATIONNLOCATIONSIVEHICLES/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
xith regard to work performed under the General Liability coverage.
CERTINCATEHOLDER CANC€LLATION;
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 IND N��T,,N(F.,.(�,OMPANY S E OR REPRESENTATIVES
Greeley, CO 80632 ORI ESFtrfA'rlvE
6,--- k L.`A000.204 woo /CORPORATION 1988
C vnae`r % 12C ov-79/99 ggcsgln
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