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<br />ACORDN CERTIFICATE OF LIABILITY INSURANCE cSR I DATE (MMIDDIYYYY) <br />LAKEM-1 06/10/04 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Hix Insurance Associates, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />4440 Arapahoe Ave., Ste 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />f\lder CO 80303 <br />1';~d~e:303-444-4666 Fax:303-444-8481 INSURERS AFFORDING COVERAGE NAlc# <br />INSURED INSURER A: American AI ternative Insurance <br /> INSURER B: <br /> Lake Meredith Reservoir CO. INSURER C: <br /> POBox 8 INSURER 0: <br /> Ordway CO 81063 <br /> INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR NSRI TYPE OF INSURANCE POLICY NUMBER '-DATE iMMIDDrm I P8kw;.'/MMIDorm' LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> ., - PREMISEs'(E~=~ncel <br />A X COMMERCIAL GENERAL LIABILITY SDISSK91003141 06/01/04 06/01/05 $ 1,000,000 <br /> I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10,000 <br /> X D&O and EPLI PERSONAL & ADV INJURY $ 1, oeo , 000 <br /> - <br /> GENERAL AGGREGATE $3,000,000 <br /> - <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,000 <br /> I n PRO- nLOC Emp Ben. 1,000,000 <br /> POLICY JECT <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 <br /> ~ <br />A ANY AUTO SDSA90001661 06/01/04 06/01/05 (Ea accident) <br /> - <br /> ALL OWNED AUTOS BODILY INJURY <br /> - $ <br /> SCHEDULED AUTOS (Per person) <br /> - <br /> ~ HIRED AUTOS < BODILY INJURY <br /> $ <br /> X NON-OWNED AUTOS (Per accident) <br /> - <br />1(':::,(:" - PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> =l Atf'f AUTO OTHER THAN EAACC $ <br /> AUTO ONLY: AGG $ <br /> . <br /> EXCESSNMBRELLA LIABILITY . EACH OCCURRENCE $1,000,000 <br />A :=J OCCUR Ii] CLAIMS MADE SDISSX92000761 06/01/04 06/01/05 AGGREGATE $1,000,000 <br /> $ <br /> ~ DEDUCTIBLE $ <br /> X RETENTION $-0- $ <br /> WORKERS COMPENSATION AND I TORYLIMITS I I v JR'- <br /> EMPLOYERS' LIABILITY $ <br /> ANY PROPRIETORlPARTNERlEXECUTIVE E.L. EACH ACCIDENT <br /> OFFICERlMEMBER EXCLUDED? E.L. !)IS~SE - EA EMPLOYEE $ <br /> ~~~.if~~v'js1oNS below E.L. DISEASE - POLICY LIMIT $ <br /> OTHER <br /> 4 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />COLOR60 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN <br />Colorado Water Conservancy Bd NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Water Supply Planning IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR <br />Attn: Steve <br />1580 Logan St Ste 750 REPRESENTATIVES. <br />Denver CO 80203 AUTHORIZED REPRESENTATIVE <br /> Charles Hix <br /> <br />ACORD 25 (2001/08) <br /> <br />@AcORDCORPORATlON 1988 <br />