HomeMy WebLinkAbout970411.tiff a':"'�t,• CERTIF LATE F INSURA E ' DATE(IAMImD/TY)
PAODUtER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
All American Agency Facilities ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Van Gilder Insurance Corp. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
700 Broadway, Suite 1000 COMPANIES AFFORDING COVERAGE
Denver , CO 80203 PR COMPANY
303-837-8500 A Carolina Casualty
INSURED
COMPANY
Weld County Youth Alternatives B Union Insurance Co .
Inc . dba Weld County Partners COMPANY
1212 8th Street C
Greeley CO 80631 COMPANY
I D
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,NOTWITHSTANDINGANY REQUIREMENT,TERMOR CONDITION OFANYCONTRACTOR OTHER DOCUMENT WITHRESPECTTO WHICHTHIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I
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
LTR DATE(MMIDDIYY) DATE(MMIDDIYY) LIMITS
GENERAL LIABILITY GENERAL AGGREGATE $ 1000000
A X COMMERCIAL GENERAL LIABILITY NP0760588 1/26/97 1/26/98 PRODUCTS.COMP/OP AGG $ 1000000
CLAIMS MADE X OCCUR PERSONAL & ADV INJURY $ 1000000
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1000000
FIRE DAMAGE(Any one fire) $ 50000
MED EXP (Any one person) $ 5000
AUTOMOBILE LIABLITY
COMBINED SINGLE LIMIT $
A X ANY AUTO NP0760588 1/26/97 1/26/98 1000000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
X HIRED AUTOS
BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABLITY EACH OCCURRENCE $ 3000000
B X UMBRELLA FORM A4875482 1/26/96 1/26/97 AGGREGATE $ 3000000
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND STATUTORY LIMITS
EMPLOYERS'LIABLITY - --- - - - -
EACH ACCIDENT $
THE PROPRIETOR/ INCL DISEASE POLICY LIMIT $
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $
OTHER
A Professional NP0760588 1/26/97 1/26/98 $1 ,000 ,000/Ea Claim
Liability $1 ,000 ,000/Aggrgate
DESCRIPTION OF OPERATIONSLOCATIONSIVEHICLESISPECIAL ITEMS
Weld County , Colorado , by and through the Board of County Commissioners of
Weld County , its employees and agents are included as Additional Insureds on
general liability policy as respects work performed by insured on their behalf
CERTIFICATE HOOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAL
Weld County 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
915 — 10 t h S t . BUT FAILURE TO MAL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Greeley, CO 80631 OF ANY KIND ON THE COMP Y. ITS GENTS OR REPRESENTATIVES.
AUTHORIZED REPR E A IVE 071627009
AC013I712g•&i3t3� `3' 970411
L9,16/- �7
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