HomeMy WebLinkAbout961526.tiff ao4ORIL CERTIFICATE OF INSURANCE: BAECMMIDDIYY)
L CERI MLA lE ISSUED AMATT EN IN HORMAIIOE
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Van Gilder Insurance Corp HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 911 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Ster Iing, CO 80751 COMPANIES AFFORDING COVERAGE
COMPANY
303-522-6260 A United States Fidelity & Guar
INSURED COMPANY
Glen and Wayne Klee B ..._.I
dba: K&K Roustabout Service COMPANY
PO Box 529 C •
-
Sterling , CO 80751 COMPANY •
D I
COYERAGtS ». .? .
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVE BEENISSUED TO THEINSURED NAMED ABOVEFOR THE POLICY PERIOD
INDICAICATE T WITHST ANDINGANYRE RUMEN.THE
RMORCONDITIONOF ANYCONTRACT DESCRIBED
SUBJECT
SPELT TO WHICHTHIS
CERTIFICATE MAY BE ISSUED ORMAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJE TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAO CLAMS. '7)
CO TYPEOF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTA DATE(MMIDDIYY) DATE(MMIDDIYY)
GENERAL LIABILITY GENERAL AGGREGATE $ 2000000
A X COMMERCIAL GEtERALLIABILITV 1MP30116209201 8/28/96 8/28/97 PRfYYTTSCOMP/OP AGO $ 2000000
CLAIMS MADE OCCUR PERSONAL a ADV INJURY $ 1000000
OWNER'S 6 CONTRACTOR'S PROT EACH OCCLRREIICE $ 1000000
FIRE DAMAGE(Any one lire) $ 50,000
AED E%P(Any one Pesos) 1 5,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
A ANY AUTO 1MP30116209201 8/28/96 8/28/97 1 ,000,000
ALL OWNED AUTOS BODILY INJURY
X SEDULED AUTOS (Per person)
CI
X HIRED AUTOS BODILY INWRV 1
X NON.OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY •EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
:...........................
AGGREGATE $
EXCESS LIABILITY EACH OCCLI:TERCE 1
-1 UMBRELLA FORM AGGREGATE $
OTHER THAN UMBG LLA FORM $
...................
WORKERS COMPENSATION AND STATUTORY LIMITS
EMPLOYERS'LIABILITY
EACH ACCIDENT 1�
THE PROPRIETOR/ INCL DISEASE-POLICY LIMIT $
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL DISEASE.EACH EMPLOYEE $
OTHER
A Contractors Equip LIMIT ALL RISK 8/28/96 8/28/97 $62;500
DESCRIPTION OF OPERATIONSILOCATIONS(4EHTOLESISPECIAL ITEMS
Orig: Cert Holder CC: Insured CC: USF&G/Van Gilder
CERTipICATE;:H[)LOI:R ;': ;; CANCELLATfON:; .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAL
We I d County 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
PO Box 758 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Greeley, CO 80632 OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
ATTN: Allen Miller kistiORLIJOEPRESEN,I5VE v 577461000
�.�M tlRb26I8(.3l83J (� ///IR �awN."'AUree.Y :
L 1//7t G 961526
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