HomeMy WebLinkAbout972582.tiffCERTIFICATE OF INSURANCE
A Stock Company
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSU LICY AND
DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BV THE TLP@19iN.
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This is to Certify
(Name and address
minsured)
Is. at Ne Hun eat.
patcy.$) Is nt1.dteal
or oilier document '.N,
that [-Morgan
20169
I Fort
R.E.A.
Hwy. 34
Morgan, C.10 80701 (P97 RCN
company mastthe edaCYees) Used below. The insurance artdded
caWeau and if vet and by any r.W,am,t, two be =note
nay be Issued.
TO TI
i
3 I 41_21. (PD
by the taoS
LI Erii\ G
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Name by
al Ilia ca iente, the
yea try wanton* aM
respect to :Mid, ads cattiest.
11875 W. 85th Street P.O Box 15147 Lenexa, KS 66285-5147 (913)541-0150 (800)356-8360 Facsimile (9 3j54T- 004
TYPE OF INSURANCE
POLICY
NUMBER
POLICY
EXPIRATION
DATE
Limits of liability in Thousands (000's)
EACH
OCCURRENCE
AGGREGATE
GENERAL LIABILITY
[X] COMPREHENSIVE FORM
[XI PREMISES - OPERATIONS
[XI EXPLOSION AND COLLAPSE
HAZARD
[X] UNDERGROUND HAZARD
[X] PRODUCTS/COMPLETED
OPERATIONS HAZARD
[XI CONTRACTUAL INSURANCE
[XI BROAD FORM PROPERTY
DAMAGE
[X] INDEPENDENT CONTRACTORS
[X] PERSONAL INJURY
S ARE 020-97
1-1-99
BODILY INJURY AND
PROPERY DAMAGE
COMBINED
$2,000
N/A
AUTOMOBILE LIABILITY
(XI COMPREHENSIVE FORM
[XI OWNED
[Xi HIRED
[X] NON -OWNED
5 ARB 020-97
1-1-99
BODILY INJURY AND
PROPERY DAMAGE
COMBINED
$2,000
N/A
EXCESS LIABILITY INCLUDING
AUTO & GENERAL
[X] UMBRELLA FORM
BODILY INJURY AND
PROPERY DAMAGE
COMBINED
N/A
N/A
WORKERS' COMPENSATION
and
EMPLOYER'S LIABILITY
5 Ivy 020-98
1-1-99
STATUTORY
$500 (Each Accident)
$500 (Disease - Policy Limit) '
$500 (Disease - Each Employee)
[XI ALL RISK PROPERTY INCLUDING
PHYSICAL DAMAGE ON VEHICLES
•
5 ARE 020-97
1-1-99
Deductibles
Property Limit
$500 Ccmp.
$500 Collision
All Risk Blanket
$500 Property
DESCRIPTION OF OPERATIONS
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DATE ISSUED: 11-21-97 Cb
1 C:Y w...,..vUaviv v 2 . :. Lirm L,.b .v.;.n>CJ.[ n.. n.saw...
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NAME AND ADDRESS /�..1OF CERTIFICATE �HOLDER `€:i:
Weld' ilnaaa % Board of Ctun (12rrnisS1.O11ers :,,
tC�yFw.� tY
915 10th Street
Greely, CO 80631
rr1
iiiiii
$11,864,723 Limit
;i .i:
r.,>..: 1111.. ., .
'r CANCELLATION:
SHOULD ANY OF THE ABOVE
[ BEFORE THE EXPIRATION
WILL ENDEAVOR TO MAIL
CERTIFICATE HOLDER, BUT
f IMPOSE NO OBLIGATI
MPANY, ITS
ii
.;: -;
111.......
DESCRIBED POLICIES
DATE THEREOF, THE ISSUING
30 DAYS WRITTEN
zw. >
�.. ..
BE CANCELLED
COMPANY
NOTICE TO THE
NOTICE SHALL
UPON THE
n
FAILURE TO MAIL SUCH
OR LIABILITY OF ANY KIND
OR REPRESENTATIVES.
AUTHORIZED REPRESENTAT
20widWo O7
FED -100 (4-92)
I'
972582
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