1996-11-08_GENERAL DOCUMENTS - C1981017 ‎(2)‎

• Permit No: C1981017
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 11/8/1996
• Doc Name: Bid Documents ‎(IMP)‎
• Media Type: D
• Archive: No

4-29-1996 8: 17AM FROM FROST MCGAHEY INS. 970 453 5935 P. 1
CERTIFICATE OF INSURANCE
'ISSUE DATE 011/25/96
PRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
Frost McGahey Inrauxance, Inc. I NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND,
P.O. Box 8410 ) EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
235 South Ridge Street -
Breckenridge, CO 80424 ( COMPANIES AFFORDING COVERAGE
( COMPANY LETTER A: UNION INSURANCE COMPANY
(
COMPANY LETTER B:
INSURED ( COMPANY LETTER C:
Ray Ward Trucking. Ray Ward and Guyrene Ward dba
30193 Highway 84 ( COMPANY LETTER De
Dolores, CO 81323 {
( COMPANY LETTER E:
I
1
COVERAGES
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION 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 TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO ) { I POL. EFF. I POL. xxP. {
LTRI TYPE OF INSURANCE ( POLICY NUMBER I DATE I DATE
I LIMITS
i
(GENERAL LIABILITY I ( ( I GENERAL AGGREGATE $ 1,000,000
A I(XI COMMERCIAL GENERAL LIABILITY( UPI(5023812 104/01/96 ) 04/01/97 { PRODUCT-COMP/OPS AGG. $ 1,000,000
( ( I CLAIMS MADE (XI OCCUR. I I ( I PERSONAL 6c ADV. INJURY S 11000,000
( ( I OWNER'S & CONTRACTOR'S PROT.( I I I EACH OCCURRENCE S 1,000,000
I ( I I I I I FIRE DAMAGE (Any one fire) S 50,000
I ) I ( MED. EXPENSE (Any one person)S S,000
,
(AUTOMOBILE LIABILITY ) I {
it I ANY AUTO ( I ( ( COMBINED SINGLE LIMIT 5
it I ALL OWNED AUTOS ( I I I
IC I SCHEDULED AUTOS I I I I BODILY INJURY (Per person) S
I ( I HIRED AUTOS I ( I I
( ( I NON-OWNED AUTOS { I ( ( BODILY INJURY (Per Accident) S
I( 7 GARAGE LIABILITY ( I I I
IL 1 ( I I ( PROPERTY DAMAGE $
(EXCESS LIABILITY ( I I
I ( 3 UMBRELLA FORM I I I EACH OCCURENCE S
{I I OTHER THAN UMBRELLA FORM J I ( ) AGGREGATE S
( WORKER'S COMPENSATION I I ( ( { STATUTORY LIMITS
AND I I I I EACH ACCIDENT $
I I ( DISEASE-POLICY LIMIT S
EMPLOYER'S LIABILITY { ( I I DISEASE-EACH EMPLOYEE S
IOTHER I I ( I
I I I I I $
I I ( I I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
ADDITIONAL INSURED LISTED AS: DEPARTMENT OF MINERALS AND GEOLOGY
CERTIFICATE HOLDER CANCELLATION
IS14OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
IBEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY
(WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE
(CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL
SUCH NOTICE SHALL TMOOSE NO OBLIGATION OR LIABILITY OF
ZANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
DIVISION OF MINERALS AND GEOLOGY I
[AUTHORIZED REPRESENTATIVE
1313 SHERMAN STREET ROOM 215 I
DENVER, CO 80203
I � .
FORM 25-S (7/90)