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Home My WebLink About20140188.tiff A CERTIFICATE OF LIABILITY INSURANCE °12/2„201'3°""" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER CONTACT MARSH USA INC. NAME: 540 W. MADISON PHONE FAX CHICAGO, IL 60661 (A/C No' Esti' INC. No): E-MAIL Att : Chicago.CortRequest@Marsh.com; Fax: 212-948-0770 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC It 400122-BAJA-GAWU-14-15 PROP INSURER A : Sentry Casualty Company 28460 INSURED Sentry Insurance A Mutual Co 24988 TELEPHONE AND DATA SYSTEMS, INC. INSURER B : TDS BAJA BROADBAND, LLC INSURER C : North American Elite Insurance Company 29700 30 N. LASALLE ST., STE 4000 CHICAGO, IL 60602 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-004727911-09 REVISION NUMBER: 1 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. INSR ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (M/DDPOLICY/YYYY) (M/DD/Y POLICYYYP Y) LIMITS A GENERAL LIABILITY 90.02578-11 01/01/2014 01/01/2015 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 2,000,000 PREMISES (Ea occurrence) $ X CLAIMS-MADE OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000 X POLICY PRO- FCT LOC $ B AUTOMOBILE I.'ABILITY 90-02576-04 01/01/2014 01/01/2015 COMBINED SINGLE LIMIT X ANY AUTO 5,000,000 (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED SCHEDULED - AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ $ C X UMBRELLAUAB X OCCUR UMB200008300 01/01/2014 01/01/2016 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION $ 25'000 90-02578-01 (AOS) $ B WORKERS COMPENSATION 01/01/2014 01/01/2015 X WC STATU- OTH- A AND EMPLOYERS' LIABILITY Y / N TORY I IMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE 90-02578-02 (WI,M4,NY,ND,OH,WA) 01/01/2014 01/01/2015 1,000,000 OFFICER/MEMBER EXCLUDED? N N /A E.L. EACH ACCIDENT $ (Mandatory in NH) R yes, describe under EL. DISEASE - EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RECEIVED Cedificate Holder is included as Additional Insured as respects General Liability to the extent required by contract. JAN JAI 1 E 7'1S?,} WELD COUNTY COMMISSIONERS CERTIFICATE HOLDER CANCELLATION Weld County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: County Commissioner THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 758 ACCORDANCE WITH THE POLICY PROVISIONS. Greeley, CO 80632 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ...tkas :!assn .a' • © 1988-2010 ACORD CORPORA 2014-0188 /� 1 /A 1 ACORD 25 (2010/05) / The ACORD name and logo are registered marks of ACORD �hu/ Ulfnail it )/21U n n n n .ii Hello