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<br />, <br /> <br />~RTlFICATE OF INSURANC' <br />issued by the <br />COLORADO COMPENSATION INSURANCE <br />720 S. COLORADO BLVD, SUITE 100, NORTH TOWER, <br />DENVER, CO 80224. <br />(303) 782-4000 <br /> <br />CERTIFICATE HOLDER: <br /> <br />AlJ62 8 <br />T99l <br /> <br />MAIL TO: <br /> <br />LIDSTONE & ANDERSON INC <br /> <br />760 WHALERS WAY <br />B-200 <br />FORT COLLINS, CO 80525 <br /> <br />TO WHOM IT MAY CONCERN: <br />TillS IS to celtlty that this company has issued a Standard Workers' Compensation and Employers' <br />Liability Policy as described below covering the liability imposed upon subject employers by the <br />Workers' Compensation Act of Colorado, said policy being in good standing as of this date. <br />POLICY NUMBER: 2069522 08/22/1997 <br /> <br />POLICY PERIOD: 07101/1997 TO 07/0111998 <br />INSURED: <br />LIDSTONE & ANDERSON INC <br /> <br />760 WHALERS WAY <br />B-200 <br />PORT COLLINS. CO 80525 <br />ORIGINAL EFFECTIVE DATE: 06/2811988 <br /> <br />IMPORT ANT: THE COVERAGE DESCRIBED ABOVE IS IN EFFECf AS OF THE ISSUE DATE OF THIS <br />CERTIFICATE. IT IS SUBJECf TO CHANGE AT ANY TIME IN THE FUTURE. <br /> <br />Altera.tion of this document is a criminal offense pursuant to Colorado Criminal Code 111-5-103: "A <br />person commits second degree forgery, if, with intent to defraud, he falsely makes, completes, alters, <br />m" utters a written instrument which is or purports to be, or which is ealculated to become or to <br />r(!present if completed: . . . a commercial instrument. . ." <br /> <br />Holders of this certificate may contact our Customer Service Department at (303) 782-4000 to verify <br />coverage for the working classification listed on the back of the certificate. <br />("SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL") <br /> <br />lJIIISlI(Xl o..-_o.,p... 0I/U'199'I ~~ ~lJt6 UW.". -I <br />