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JUL-18—'97 FRI 16: 12 ID:DOLORES PUBLIC LIBRA TEL NO:970 882 2224 #272 P02" <br /> unow/nu»i fall fill <br /> POLICY INFORMATION PAGE <br /> FEBRUARY 25, 1997 <br /> POLICY NUMBER; 3528781 <br /> COLORADO <br /> COMPENSATION OWNERSHIP: PARTNERSHIP <br /> INSURANCE POLICY TYPE: ADVANCE <br /> ITEM 1. NAME AND ADDRESS OF INSURED <br /> GUYRENE WARD AND RAY M W RD DBA RAY ` <br /> r" <br /> WARD TRUCKING <br /> 30193HWY184 <br /> DELORES CO 81323 <br /> PERATIONS COVERED <br /> LOCATIONS - ALL USUAL D AND AEREOLOCATED AT THE ABOVE ADDRESS F THE INSURED AT OR FROM CUNOLESS OOTHHERWIS <br /> THIS POLICY ARE CONDUCTED <br /> STA`T£D <br /> 02119/1997 TO <br /> ITEM 2. POLICY PERIOD: 120MA 8 <br /> MOUNTAIN STAND AR TIME <br /> ITEM 3. A. WORKERS' COMPENSATION INSURANCE: P T ENE OF THE POLICY APPLIES TO THE WORKERS' <br /> COMPENSATION LAW OF THE STATES <br /> COLORADO <br /> g, EMPLOYERS <br /> LTHEI LIMITS OP OUR LIABILITY UNDERHPART ITWO A EIES TO WORK IN EACH STATE LISTED <br /> IN ITEM <br /> BODILY INJURY BY ACCIDENT $100.000 EACH ACCIDENT <br /> BODILY INJURY BY DISEAS S100,000 EACH EMPLOYEE <br /> BODILY INJURY BY DISEAS $500,000 POLICY LIMIT <br /> C. OTHER STATES INSURANCIE PART THREE OF THE POLICY APPLIES TO THE STATES, IF ANY, LISTED HERE: <br /> NONE <br /> (CONTACT U FOR INFORMATION OUTSIDE THE STATE OF COLORADO) <br /> D. THIS POLICY INCLUDES THE ATTACHED ENDORSEMENTS AND SCHEDULES: <br /> ITEM 4, THE AENIURMAT RATING PLANS, LI IN OIRMATION R UI RED BELOW IS SUBJENED BY OUR CT FVERIFICATIONTO AND CHANGE <br /> RULES, CLASSIFICATIONS, <br /> RATESS D <br /> BY AUDIT_ THE STATEMENTS OF ESTIMATED ADVANCE PREMIUM ARE HEREBY MADE A PART OF THIS <br /> POLICY, <br /> Colorado Compensation Insurance Autho ty*720 S. Colo- Blvd. Ste. 100-N•Denver,CO 80222• (303) 782-400001-800-873-7 <br /> Colorado Business--Our Business Since 1915 LPDATED 8/96 P401-01 <br />