PERMFILE61077 - Laserfiche WebLink

Home Browse Search

., CERTIFICATE OF INSURANCE _- WORKMEN'S COMPENSATION & LIABILITY ONLY This certificate is issued as a matter pl inlormation poly and confers no rights upon the certificate holder. This certificate does not amend, end or alter the coverage atlorded by the policies listed below. Job No. 5712 owner t,oloraao ueoarzmen>; or natural tcesources, mtneo Lana rteclamatiton ulvl~lun. iai~ contractor Sherman fit.. Denver. CO 80203 Architect/Engineer Insured Rvan Incorporated Central; Rvan Incorporate of Wisc. P.O. Box 206. Janesville. WI 53547 Agent Cobb, Strecker, Dunphy & Zimmermann, Inc. Address 2702 International Lane. Madison. WI 5370 Poliey No. WL t5U UL4 35 tSd Effective ~7 .,~7 ou txpnauon ~r •+~r .+• Insurance company Transportation Insurance Company Address Milwaukee. Wisconsin Coverage -Workmen's Compensation, Statutory. Employer's Liability Limit $ 1.000.000. /$1.000.000. / each accident PUBLIC LIABILITY: 1,000,000. Pnnev Nan C'~50 024 31 78 Ettective 9/30/86 Expiration 4/30/87 Insurance company Transportation Insurance Company Address Milwaukee. Wisconsin Type of Policy: ®Comprehensive ^Other LIMITS: Bodily Injury $ Each Occurrence Property Damage $ Each Occurrence S Aggregate ~ $ Aggregate Personal Injury $ Aggregate - OR - Combined Single Limit $ 1 .000.000. Each Occurrence COVERAGE PROVIDED (Check Applicable Squarel: Yes No Operations of Contractor ® ^ Operations of Sub•Contractor (contingent) ® ^ Does Personal Injury include claims related to employment? ® ^ Completed Operations/Products ^x ^ Contractual Liability (broad form) ® ^ Exceptions: Yes No Governmental Immunity is waived ^ Property Damage liability includes: Damage due to blasting Damage due to collapse ® ^ Damage to underground facilities ® ^ Broad Form Property damage ® ^ AUTOMOBILE LIABILITY Policy No. 31 79 Etfective 9/30/86 _ Expiration 9/30/87 Insurance Company Transportation Insurance Company Address Milwaukee. Wisconsin Type of Poliey: ®Comprehensive ^Other LIMITS: Bodily Injury: $ Each Person - OR - $ Each Occurrence Combined Single Limit $ 1.000.000. Each Occurrence Property Damage $ Each Occurrence Yes No Coverage is provided for operation of all owned, hired and non owned vehicles ® ^ UMBRELLA EXCESS LIABILITY INCLUDING AUTOMOBILE LIABILITY: Policy No. UMB 30 044 Z6 84 Effective 9/3U/86 Expiration 9/3U/if/ Insurance Company Continental Casualty Company Address Chicano, Illinois LIMITS: Single limit Bodily Injury and Property Damage $ 1, OOOiOOO. Each Occurrence Yes No COVERAGE PROVIDED: Applies in excess of the coverages listed above for Employer's Liability, Public Liability and Automobile Liability SUBJECT TO THE TERMS OF THE POLICY. ® ^ Are any deductibles applicable to bodily injury or property damage on any of the above coverages? If so, list. ^ AGENT CARRIES ERRORS AND OMISSIONS INSURANCE ® ^ ~uld any o! the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail en days written notice to the OreTdlaUlYrJltltltcertificate holder, but lailure to mail such notice shall impose no obligation or liability of any kind upon the company. 1 Dated at Madison, Wisconsin op 12/16/86 By ~'~(~ ~. U,)OiQ~y,(1 Authorized Insurance Representative Construction Intlu,[ry Cooperative Committee of Minnesota -Form C.I.C.C.-7p1, Feb. 1961. Rev. June 1969, Rev. Jan 1971, Rev. Nov. 1977 Printetl by H. A. Rooarr Co., 2327 Wayzata 61vd., MPIf , 55405, 7774670