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<br />:~:~:\@j ISSUE DATE (MM/DOM')
<br />,,;.:.,:->:.'.,;,:.,','
<br />09123/92
<br />
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<br />iii 7.'fti'lI,m,. tM
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<br />
<br />PRODUCER
<br />
<br />AR17lllRJ. GALLAGHER /if CO.
<br />P.O. BOX24809
<br />DENVER. CO 80224
<br />
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
<br />CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
<br />DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
<br />POLICIES BELOW.
<br />COMPANIES AFFORDING COVERAGE
<br />
<br />(303) 773.9999
<br />JOHN MCLAUGHliN
<br />
<br />COMPANY A
<br />lETTER NAnONAL UNION FIRE INSURANCE COMPANY
<br />
<br />INSURED
<br />
<br />COMPANY B
<br />lETTER
<br />
<br />COLORADO IN711RGOVERNMENTAL RISK SHARING AGENCY.
<br />WORKERS' COMPENSAnON POOL
<br />950 SOUTH CHERRY S'rREET. SlRTE 800
<br />DENVER. CO 80222
<br />
<br />
<br />D
<br />
<br />C
<br />
<br />E
<br />
<br />~&!!f;;:;;;;;:;!!.ii;:;;:F:"""'.;;ii:!:;]:......:!'}' .... .. ........'...................;: .......................... ..................;;;?i;:;' .......
<br />.....,....'TH.'s..i;3"To.. CERTIFY THAT THE POLICIES' of''''i'NSU'RANCi~: LISTED BElOW'HAVitBEEr:tissUED TO THE INSURED NAM'ED ABOVE FOR THE POLi"Cy....PE.RI.OO.:.;.;.:.:.;<.:.".;.;.
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFiCATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAlO CLAIMS.
<br />
<br />CO;
<br />LTR; TYPE OF INSURANCE
<br />~GENERAL UABIUTV
<br />'COMMERCIAl GENERAllJABIUTY
<br />
<br />POUC'f NUMBER
<br />
<br />: POUCYEfFECTlVE ':POUCy'EXj)iiiAnON"'!'"
<br />DATE (MM/DDIYY) . DATE (MM/DDM') .
<br />
<br />UMITS
<br />
<br />',',:-:-;.'..,.
<br />':;::;:::::::,:::
<br />
<br />) CLAIMS MADE)
<br />
<br />!OCCUA.
<br />
<br />! GENERAL AGGREGATE i$
<br />! PRQDUCTS-COMP/OP AGG. is
<br />i PERSONAL S. ADV. INJURY is
<br />! EACH OCCURRENCE i$
<br />! FIRE DAMAGE (Any one'fi~~)"" """Ts'"
<br />~'MEii 'EXPENSE 'iA~y'~~~' p~rs~;;j 'T'
<br />
<br />~ OWNER'S & CONTRACTOR'S PROT.
<br />
<br />': AUTOMOBILE UABIUTY
<br />~ANY AUTO
<br />~ALl OWNED AUTOS
<br />\ ...,.....;SCHEDULED AUTOS
<br />~..<...,.. !HIRED AUTOS
<br />; NON-oWNED AUTOS
<br />~GARAGE LIABILITY
<br />
<br />: COMBINED SINGLE
<br />: LIMIT
<br />
<br />:$
<br />
<br />: BODILY INJURY
<br />~ (per Person)
<br />
<br />~$
<br />
<br />:BODllY INJURY
<br />:(Per AccIdent)
<br />
<br />$
<br />
<br />-...-.....,....."...."..........
<br />~ PROPERTY DAMAGE
<br />
<br />:$
<br />
<br />i EXCESS UABIUTV
<br />... iUMBAELlA FORM
<br />:OTHEA THAN UMBRELlA FORM
<br />
<br />EACH OCCURRENCE
<br />
<br />A
<br />
<br />WORKER'S COMPENSATION
<br />
<br />415-3178
<br />
<br />01/01/92
<br />
<br />01/01/93
<br />
<br />STATUTORY LIMITS
<br />: EACH ACCIDENT
<br />(OiSEASE:POUCV'UM'iT"
<br />!iJiSEASE-eACH"EMPlOVEE
<br />
<br />. ,':,.
<br />!$
<br />
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<br />
<br />AND
<br />
<br />is 1,000,000
<br />:$ ....1;000;0<<)......
<br />
<br />EMPLOYER'S UABIUTV
<br />
<br />[OTHER
<br />
<br />DESCRIPTION Of OPERATlONS/LOCAnONSNEHICLES/SPECIAL ITEMS
<br />MEMBER: 10WN OF IGNACIO
<br />
<br />REGARDING lRRIGA110N PROJECT.
<br />
<br />SELF INSURED Rl!Tl!N11ON EACH ACCIDENT OR EACH EMPLOl'EE
<br />FOR DISEASE, $400,000.
<br />
<br />
<br />STATE OF COLORADO
<br />cia TOWN OF IGNACIO
<br />P.O. BOX 459
<br />IGNACIO, CO 81137
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO
<br />MAIL~ DAYS WRllTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
<br />LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
<br />LIABILITY FAY KJND P THE COMPANY S AGENTS OR REPRESENTATIVES.
<br />
<br />
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