HomeMy WebLinkAbout150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (3)'Policy Issued By
Shelter General Insurance Co.
Columbia, MO 65218-0001
® 1-800-SHELTER
These Declarations are part of your policy
and replace all prior Declarations.
(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-E 100-01)
4025 AUTOMATION WAY
STE C4
FORT COLLINS CO 80525
PHONE: 970-377-2070
Notice to the Mortgagee/Loss Payee/Designated Insured: Your interest
will be continuous until cancellation notice is mailed to you.
Motor Carrier Coverage
Policy Number: 05-1-C-4999249-6 Effective Date: March 17, 2010, 12:01 A.M. Central Time
Policy Form Number: CA 00 20 0306 Expiration Date: September 17, 2010, 12:01 A.M. Central Time
(Item #3) Vehicle Year Make/Model
1994 INTER #AAAA3527
(Item #2) Coverages
BODILY INJURY AND PROPERTY DAMAGE
COLLISION
COMPREHENSIVE
SPLIT UNINSURED MOTORIST (COVERAGE)
CO UNINSURED MOTORISTS COV LIMITS
Vehicle ID
1 HTSDPPNORH578074
Coverage
Limit/ Endorsement
Premium
Symbol
Deductible Number
67
$1,000,000 LIMIT
$309.00
67
$500.DEDUCTIBLE
$141.00
67
$500 DEDUCTIBLE
$ 64.00
67
$500,000 PER ACCIDENT CA 21 02 11 06
CA 21 50 0108
Other Endorsements Attached To This Policy
ADDITIONAL INSURED CITY OF GREELEY
DESIGNATED INSURED CITY OF FORT COLLINS
DESIGNATED INSURED CITY OF BRIGHTON
LOSS PAYABLE CLAUSE
AMENDATORY ENDORSEMENT
CHANGES
COMMON POLICY CONDITIONS
NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT
CO CONCEALMENT, MISREPRESENTATION OR FRAUD
CO CHANGES - CANCELLATION AND NONRENEWAL
Endorsement Number
CA 20 0103 06
CA 20 48 02 99
CA 20 48 02 99
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
IL 02 28 09 07
LOSS PAYEE:
ADDL INSURED:
ADDL INSURED:
ADDL INSURED:
GUARANTY BANK AND TRUST
CITY OF GREELEY
CITY OF FORT COLLINS
CITY OF BRIGHTON
ISAOA
1000 1OT" ST
300 LAPORTE AVE
22 S 4T" AVE
4650 ROYAL VISTA DR
GREELEY CO 80631-3808
FORT COLLINS CO 80521-2719
BRIGHTON CO 80601-2030
FORT COLLINS CO 80528-0000
(For Office Use Only)
P.C. RATE CLASS 16A
TERRITORY 6 TERM 6
H.O. CODE 544.00 09162009 DATE ISSUED: 03232010
COST SYMBOL F PACKAGE -CD 1 TIER: N/A
gl
Countersigned By
A-2.54-A
Shelter Insurance Companies
1817 W Broadway
Is
Columbia, MO 65218
,,=-.0W-LM 1-800-SHELTER
CITY OF FORT COLLINS
300 LAPORTE AVE
FORT COLLINS CO 80521-2719
***MANUAL DEC***
POLICY NUMBER: 05-1-C-4999249-6