HomeMy WebLinkAbout960276.tiff ACDIIIeI1® CERTIFICATE OF INSURANCE DATE
(ff796
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins . Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. BOX 578 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W. 18th Street COMPANIES AFFORDING COVERAGE
Greeley, CO 80632 COMPANY
AAetna Casualty & Surety Company
INSURED COMPANY
Weld Adolescent Resources BColorado Compensation Authority . .
Jesse Quinby dba COMPANY
3412 Lupton Avenue c
Evans, CO 80620 COMPANY
D
I
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.
TYPE OF INSURANCE POLICY NUM BER
LTR POLICY EFFECTIVE OLICY EXPIRATION
LIMITS
DATE(MM/DD/YY) �DATE(MM/DD/r0
A GENERAL LIABILITY ACM25259037 02/01/96 02/01/97 GENERAL AGGREGATE $2, 000, 000
X COMMERCIAL GENERAL LIABILITY PRODUCTS.COMP/OPAGG s2 , 000 , 000
CLAIMS MADE XI OCCUR PERSONAL&ADV INJURY $1, 000, 000
W NER'S&CONTRACTOR'S PROT EACH OCCURRENCE $1, 000, 000
FIRE DAMAGE(Any one f ire)$5 0, 0 0 0
MED EXP(Any one person) $5, 000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
I ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
(Per person)
SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $
(Per accident)
NON-OWNED AUTOS
I PROPERTY DAMAGE $
GARAGE LIABILITY —II AUTO ONLY-EA ACCIDENT $
_
_ ANY AUTO OTHER THAN AUTO ONLY:
J EACH ACCIDENT $
— - _ AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
_ OTHER THAN UMBRELLA FORM $
B WORKERS COMPENSATION AND 3121780 07/01/95 07/01/9g—n
LSTATUTORY LIMITS
EMPLOYERS'LIABILITY EACH ACCIDENT t$100 , 000
THE PROPRIETORI n INCL ITOISEASE PO'_ICY IM!T $500, 000
PARTNERS/EXECUTIVE DISEASE-EACH EMPLOE $100 , 000
OFFICERS ARE: EXCL` Y
OTHER
--1
Jy (am) ... a
DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS 'T h V 0
.7 LjO a
) f
1 1~? a—C
CERTIFICATE HOLDER CANCELLATION t 7t
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Weld County EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
915 10th Street 1 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Greeley, CO 80631 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
./GI rit OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
11 II AUTHORIZED EP SENTATIVE
ACf)RD2S-S(G(s3)1 oil #857893/M578'91 OJG eACOf 960276
Hello