HomeMy WebLinkAbout960700.tiff ACOOrne CERTIFICATE OF INSURANCE B$DEUATE(MM/DD Y)
2 . 04/04/96
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
BURGESS INSURANCE AGENCY CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
9100 WEST JEWELL AVE#100 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
P.O.BOX 150037
LAKEWOOD CO 80215-0037 COMPANIES AFFORDING COVERAGE
ER"Y
TT A CNA Insurance Company
i
INSURED LETTER B California Indemnnity Insurance -: r IJ " i 0
I_-I1 c:p '")COMPAFasick Concrete, Inc.
LETTER
a
Firemans Fund Insurance Company r
C/0 Jay L. Fox, Inc. COMPANY -n I ,
I —I
441 Wadsworth Blvd. LETTER D _
Lakewood,Colorado 80226 COMPANY ',CDLETTER E
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
L$R DATE(MM/DD/YY) DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGGR. $ 2,000,000
CLAIMS MADE X OCCUR. PERSONAL&AOV.INJURY $ 1,000,000
A OWNER'S 8 CONTRACTOR'S PROT. 1044824636 02/12/96 02/12/97 EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE(Any one fire) $ 50,000
MED.EXPENSE(Any one person) $ 5,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
X ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
A HIRED AUTOS 1044824653 02/12/96 02/12/97
BODILY INJURY • $
NON-OWNED AUTOS (Per accitlenp
GARAGE LIABILITY PROPERTY DAMAGE $
EXCESS LIABILITY EACH OCCURENCE $ 1,000,000
C X UMBRELLA FORM TBA 04/04/96 02/12/97 AGGREGATE $ 1,000,000
OTHER THAN UMBRELLA FORM
X STATUTORY LIMITS
WORKER'S COMPENSATION EACH ACCIDENT $ 100,000
B AND C1041582A 04/01/96 04/01/97 DISEASE-POLICY LIMIT $ 500,000
EMPLOYERS'LIABILITY DISEASE-EACH EMPLOYEE $ 100,000
OTHER
DESCRIPTION OF OPERATIONSAOCATIONSNEHICLES/SPECIAL ITEMS
Named Insured Reads: Fasick Concrete, Inc.,Fasick Trucking,Inc.and
Western Fasick Sealcoat, Inc.
Re:Weld County 1996 Rubberized CracMilling Project.
Weld County is listed as an additional insured.
CERTIFICATE HOLDER • • • • • • CANCELLATION
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
Weld County LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
Attn: Dean Dreher LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR RcPRPRFNTATNFA P.O. -
Box 758 AUTgORIZED REPRESENTATIVE 960700
Greeley,CO 80632 ( _ (-6( )-6/_/. Q ��,
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ACOItD•2&$I71901" k � RCORll CORPDRA'ttttN 1990
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