HomeMy WebLinkAbout991618.tiff Client# : 32117 GALAXY
ACORDTM CERTIFICATE OF LIABILITY INSURANCE 0DATE 6/(21/99
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
J. W. Terrill , Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P .O. BOX 4696E HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
St . Louis, MO 63146-6962 I
Attn : E. Knobler 314/991-1730 INSURERS AFFORDING COVERAGE
INSURED
� INSURER A:Firemans Fund Ins . Co.
Galaxy Cablevision etal - --
INSURERS National Surety Co. (FFX)
1220 North Main Street INSURER c:
Sikeston, MO 63801
INSURER D
I INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRRATION
TYPE OF INSURANCE POLICY NUMBER PDATE(MM/DONNICY EFFECTIVE POATE(MMLICY DD/YY
LTR PATE(MM/DD/VY1 DATE(MM/DD/YY� LIMITS
A • GENERAL LIABILITY DXX80736367 06/23/99 06/23/00 11 EACHOCCURRENCE I$l, QQQ , COO
X COMMERCIAL GENERAL.LIABILITY PRE DAMAGE:(Any one ore)$1, 000 , C 0 0
CLAIMS MADE X OCCUR I MED EXP(Any one person) $ 10, 000
I PERSONAL B ADV INJURY $1, 000, C'00
11 GENERALAGGREEGATE $2 , 000, C 0 0
GENII_AGGREGATELIMITAPF'LIESPER: PRODUCTS-COMP/OP AGO $2 , 000, 000
POLICY X JECT PRO- 1 I LOC
A I AUTOMOBILE LIABILITY DXA80196755 06/23/99 06/23/0000MBINED SINGLE LIMIT
B X ANY AUTO DXA80196754TX 06/23/99 06/23/00 (Ea accident) $1, 000 , C00
ALL OWNED AUTOS 11 BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS I BODILY INJURY
(Per accident)
$
NON-OWNED AUTOS
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT'i$
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A ' EXCESS LIABILITY XYZ96134853 06/23/99 06/23/00 EACH OCCURRENCE $20 , 0.00 , 001
X OCCUR CLAIMS MADE I AGGREGATE s20, 000, 09fi
I 4
DEDUCTIBLE 1I 1. - -. - $
I RETENTION $nl.l • $
A WORKERS COMPENSATION AND I)WP808149566 06/23/99 06/23/00 I X ',pICIYLMTG.. - iEH
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT 1$500., 000
EL DISEASE EA EMPLOYEE$500 , 000
•
E.L.DISEASE-POLICY LIMIT $500 , 000
OTHER
I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate holder, its officers, borads, commissions and employees are
additional insureds on the general liability as their interest may appear.
CERTIFICATE HOLDER I ADOIDONALINSURED;INSURER LE-um CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
County of Weld DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAI L3 0 DAYSWRITTEN
Attn: Office of County Attorney NOTICETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUTFAILURE TO DO SO SHALL
P .O. Box 1948 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Greeley, CO 80632 REPRESENTATIVES.
E
AUTHORIZED REPRESENTATIV
3�..- LA) \ QO &I
ACORD25•S(7/9 1 of 2 01111903 SDW 991618
0}3tiv, L ->d=, (t / i9
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of nsurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-S(7/97)2 of 2 #1\11119 0 3
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