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d % , -t &eW&Wati0n Cob_te <br /> NAME AND ADDRESS OF AGENCY - <br /> beaasal.a ItwuranawASenc7, Inc. COMPANIES AFFORDING COVERAGES <br /> P. 0. Sam 272 <br /> Monte Vista, CO SIM LETTER_ A Firenan's Fund Insurance Co. <br /> COMPANY <br /> LETTER <br /> NAME AND ADDRESS OF INSURED <br /> Mathias, <br /> COMPANY <br /> Miathias, Concrete `l CO EA <br /> Mile Vista, CO SU44 COMPANY D <br /> LETTER <br /> COMPANY C <br /> LETTER L <br /> This Is to cerNly that policies of insurance listed below he"teen issued to the insured named above and are In force at this time. Notwostim any requirement,term or condition <br /> 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 <br /> terms,exclusions and conditions of such policies. <br /> COMPANY POLICY Limits of Liabil ty in Thousands <br /> LETTER TYPE OF INSURANCE POLICY NUMBER EXPIRATION DATE EACH AGGREGATE <br /> OCCURRENCE <br /> GENERAL LIABILITY <br /> BODILY INJURY $ S <br /> ❑COMPREHENSIVE FORM <br /> ❑PREMISES—OPERATIONS PROPERTY DAMAGE S $ <br /> ❑EXPLOSION AND COLLAPSE <br /> HAZARD <br /> ❑UNDERGROUND HAZARD <br /> ❑PRODUCTS/COMPLETED <br /> OPERATIONS HAZARD BODILY INJURY AND <br /> ❑CONTRACTUAL INSURANCE PROPERTY DAMAGE $ $ <br /> ❑BROAD FORM PROPERTY COMBINED <br /> DAMAGE <br /> ❑INDEPENDENT CONTRACTORS <br /> ❑ PERSONAL INJURY PERSONAL INJURY S <br /> AUTOMOBILE LIABILITY BODILY INJURY <br /> (EACH PERSON) $ <br /> ❑ COMPREHENSIVE FORM BODILY INJURY S <br /> (EACH ACCIDENT) <br /> ❑ OWNED Y DAMAGE $ <br /> ❑ HIRED <br /> BODILY INJURY AND <br /> ❑ NON OWNED PROPERTY DAMAGE S <br /> COMBINED <br /> EXCESS LIABILITY <br /> BODILY INJURY AND <br /> W <br /> ❑ UMBRELLA FORM PROPERTY DAMAGE $ f <br /> ❑ OTNERTHAN UMBRELLA COMBINED <br /> FORM <br /> WORKERS'COMPENSATION STATUTORY <br /> and <br /> EMPLOYERS'LIABILITY = �Ec.ACooENnl <br /> OTHER <br /> A Realax actin SLR06359297 8126184 $i1000.00 <br /> Mond <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES <br /> Mond will be inermWed $5,000 at such time the increase is needed. <br /> Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- <br /> pany will endeavor to mail _ days written notice to the below named certificate holder, but failure to <br /> mail such notice shall impose no obligation or liability of any kind upon the company. <br /> NAME ANDADDRESSOF CERTIFICATE HOLDER •n st 23 lAl9 <br /> DATE ISSUED' 6 711J <br /> AUTHORIZEEr REPRESENTATIVE <br />