HomeMy WebLinkAbout952204.tiff Certificate of Insurance
IIIts COLTIFIGNIF ISISSUIiD AS Y NIA ElTROI IN TOP%IA I ION ONLY AND cUNI'I'I<SNO HICI IIS UPON YOU 11II.(PRIII'Ic All'.IICIDFR_ ll Its(lRIIIiSK Il,Is NOI
AN INSURANCE POLICY AND DOES NOT AMEND,EX NI).OP AI:FILL ll I I'I O I UACI%AI 14)121)I'.I)ISY ll I I.POOL[US I.IS I I I)BII I OW.
This is to Certify that WELD Cps III
1
HENKELS 8 McCOY,INC. 3 - Name and LIBERTY
JOLLY ROAD 1995 OCT -9 IA 9: 19 4 address of MUTUAL®
BLUE BELL, PA 19422 Insured.
CLERK
1
Is,at the issue date of this certificate,insured by�uaAl{'uwr+'mdn6Cthe policy(ies)listed below. The insurance afforded by the listed policy(ies)is subject to all their
terms,exclusions and conditions and is not altered by any requirement,term or condition of any contractor other document with respect to which this certificate may be
issued. ------.
EXP.DATE
. ❑ CONTINUOUS
TYPE OF POLICY ❑ EXTENDED POLICY NUMBER LIMIT OF LIABILITY
_121POLICY TERM
WORKERS COVERAGE AFFORDED UNDER wC EMPLOYERS LIABILITY_
COMPENSATION WC2-631-004085-025 LQw OF THE FOLLOWING STATES: Bodily!dory By Accident
ALL STATES EXCEPT STATE
10/1/96 A/O $500,000. Each
WC1-631-04085-035 FUND STATES AND THE Accident
STATE OF ME I Bodily Injury By Disease
(PA) policy
$500,000. Limit
Bodily Injury By Disease
$500,000. Each
Person
GENERAL General Aggregate-Other than ProductslCompleted Operations
LIABILITY $2,000,000.
El OCCURRENCE Products/Completed Operations Aggregate
10/1/96 R32-631-004085-065 $2.000,000.
❑ CLAIMS MADE Bodily Injury and Property Damage Liability per
$2,000,000. Occurrence
Personal Injury
Per Person/
RETRO DATE $2,000,000. Organization
Other INCLUDES PRODVcrScoMPLE TED Other ALSO INCLUDES
OPERATIONS.INDEPENDENT CONTRACTUAL LIABILITY
CONTRACTORS.... _ AND XCU
AUTOMOBILE Each Accident-Single Limit
LIABILITY $2,000,000. B.I.and P.D.Combined
® OWNED 10/1/96 AS2-631-004085-045 Each Person
® NON-OWNED Each Accident or Occurrence
® HIRED Each Accident or Occurrence
OTHER
ADDITIONAL COMMENTS
ALL OPERATIONS PERFORMED BY THE NAMED INSURED
If the certificate expiration date is continuous or extended term,you will be notified if coverage is terminated or reduced before the certificate expiration date.
SPECIAL NOTICE-OHIO: ANY PERSON WHO,WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER,SUBMITS
AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW BEFORE Liberty Mutual Group
THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED
UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS
NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO. -
WELD COUNTY 300J
;ERT1FCATE P 0 BOX 758 H. Gail H r
HOLDER GREELEY CO 80632 AUTHORIZED REPRESENTATIVE
6L '�?�� Berwyn, PA (610) 251-9300 10/01/95
/L7 ! OFFICE PHONE NUMBE
Vhi.a•rtI- I is ou ended by I.1111.Rll MU I LI (A2( .IL re.poc I.'.uc hinur,In ri.ei to rd,d be IbbeComp.nlrt
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