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Home My WebLink About150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (2)11 U Policy Issued By Shelter General Insurance Co. Columbia, MO 65218-0001 ^+� o 1-800-SHELTER (Item #1) Named Insured: WALSH CONSTRUCTION INC 8139 OPEN VIEW PL LOVELAND CO 80537-9481 ***MANUAL DEC*** Policy Declarations and Schedule Agent LINDSAY ARNETT (05-E100-01) 4025 AUTOMATION WAY SUITE C4 FORT COLLINS CO 80525 PHONE: 970-377-2070 Motor Carrier Coverage Policy Number: 5-1-C-4999249-6 Effective Date: August 4, 2009 1:49 P.M. Central Time Policy Form Number: CA 00 20 03 06 Expiration Date: September 17, 2009, 12:01 A.M. Central Time (Item #3) Vehicle Year Make/Model Vehicle ID 1994 INTER #AAAA3527 1 HTSDPPNORH578074 (Item #2) Coverages Coverage Limit/ Endorsement Premium Symbol Deductible Number BODILY INJURY AND PROPERTY DAMAGE 67 $1,000,000 LIMIT $73.85 COLLISION 67 $500 DEDUCTIBLE $33.69 COMPREHENSIVE 67 $500 DEDUCTIBLE $15.29 SPLIT UNINSURED MOTORIST (COVERAGE) 67 $500,000 PER ACCIDENT CA 21 02 11 06 CO UNINSURED MOTORISTS COV LIMITS CA 21 50 01 08 Received For This Reissue: Other Endorsements Attached To This Policy ADDITIONAL INSURED WALMART STORES INC SUBAFF ADDITIONAL INSURED CITY OF EVANS ITS EMPLOYEES ADDITIONAL INSURED CITY OF LOVELAND ADDITIONAL INSURED CITY OF LONGMONT ADDITIONAL INSURED OMNI TRAX INC ADDITIONAL INSURED CITY OF GREELEY DESIGNATED INSURED CITY OF FORT COLLINS ADDITIONAL INSURED STATE OF CO DIV OF WILDLIFE LOSS PAYABLE CLAUSE AMENDATORY ENDORSEMENT CHANGES COMMON POLICY CONDITIONS NUCLEAR ENERGY LIABILITY EXCLUSION CO CONCEALMENT, MISREPRESENT OR FRAUD CO CHANGES - CANCELLATION AND NONRENEWAL *** SEE CONTINUATION PAGE FOR OTHER PARTIES *** (For Office Use Only) P.C. RATE CLASS 16A TERRITORY 6 TERM 6 H.O. CODE 544.00 06192009 DATE ISSUED: 08042009 COST SYMBOL F PACKAGE -CD 1 TIER: N/A rn MO Countersigned By w - Endorsement Number CA 20 0103 06 CA 20 01 0306 CA 20 01 03 06 CA 20 01 03 06 CA 20 01 0306 CA 20 01 0306 CA 20 48 02 99 CA 20 01 03 06 CA 99 44 12 93 A-672.3-A CA 01 13 01 09 IL 00 17 11 98 IL 00 21 09 08 IL 01 69 09 07 IL02280907 A-2.54-A NONE Policy Issued I i Shelter General Insurance Co. ��; Columbia, MO 65218-0001 ''--3 - 1-800-SHELTER ..... 1„� ADDL INSURED: WALMART STORES INC SUBAFF 2001 SE 10TH ST BENTONVILLE AR 72716-0001 ADDLINSURED CITY OF LOVELAND 410 3 5TH ST LOVELAND CO 80537-5641 ADDLINSURED OMI TRANX INC 50 S STEELE ST DENVER CO 80209-2805 DESIGNATED INSURED CITY OF FORT COLLINS 300 LAPORTE AVE FORT COLLINS CO 80521-2719 MO ***MANUAL DEC*** Policy Declarations and Schedule Motor Carrier Coverage ADDLINSURED CITY OF EVANS ITS EMPLOYEES 1100 37TH ST EVANS CO 80620-2036 ADDLINSURED CITY OF LONGMONT 1100 S SHERMAN ST LONGMONT CO 80209-2805 ADDLINSURED CITY OF GREELEY 1000 10TH ST GREELEY CO 80631-3808 ADDLINSURED STATE OF CO DIV OF WILDLIFE 6060 BROADWAY DENVER CO 30216-1029