HomeMy WebLinkAbout150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (4)5-1-C-4999249-6
Policy Issued By
Shelter General Insurance Co.
Columbia, MO 65218-0001
® 1-800-SHELTER
Namedansured
WALSH CONSTRUCTION INC
8139 OPEN VIEW PL
LOVELAND CO 80537-9481
***MANUAL DEC***
Policy Declarations and Schedule
Motor Carrier Coverage
Agent
LINDSAY ARNETT
(05-E100-01)
4025 AUTOMATION WAY STE C4
FORT COLLINS CO 80525
PHONE: 970-377-2070
Notice to the Mortgagee/Loss Payee/Designated Insured: Your interest
Will ue wnunuuus until canceuation notice is maned to you.
Policy Number: 5-1-C-4999249-6 Effective Date: May 26, 2010, 11:37 A.M. Central Time
Policy Form Number: CA 00 20 03 06 Expiration Date: September 17, 2010, 12:01 A.M. Central Time
(Item #3) Vehicle Year Make/Motlel _. u _, Vehicle ID > `_ . ;� L4
1994 INTER #AAAA3527 1 HTSDPPNORH578074�
(Item #2) Coverages.
Coverage Limit/- A End Sro ement Premium
Symbol Deductible
r ' '
Bodily Injury and Property Damage
67
$1,000,000 Limit
. _., .Number..
$309.00
Collision
67
$500 Deductible
$141.00
Comprehensive
67
$500 Deductible
$64.00
CO Uninsured Motorists Cov Limits
67
$250,000 Per Person
CA 21 50 01 08
Split Uninsured Motorist (Coverage)
67
$500,000 Per Accident
CA 21 02 11 06
Received For This Reissue: NONE
Other Entlorsements Attached To°:This
Additional Insured CITY OF GREELEY CA 20 01 03 06
Designated Insured CITY OF FT COLLINS WATERS WAY CA 20 48 02 99
Designated Insured CITY OF FORT COLLINS CA 20 48 02 99
Loss Payable Clause CA 99 44 12 93
Designated Insured CITY OF BRIGHTON CA 20 48 02 99
Amendatory Endorsement A-672.3-A
Changes CA 01 13 01 09
Common Policy Conditions IL 0017 11 98
Nuclear Energy Liability Exclusion IL 00 21 09 08
CO Concealment, Misrepresent or Fraud IL 01 69 09 07
CO Changes - Cancellation and Nonrenewal IL 02 28 09 07
(Information May Continue on Back)
(For Office Use Only)
P.C. . RATE CLASS 16A TERRITORY 6 TERM 6
H.O. CODE 544.00 03232010 DATE ISSUED: 05262010
COST SYMBOL F PACKAGE -CD 1 TIER: N/A
Countersigned Bye wh,L
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5-1-C-4999249-6
LOSS PAYEE:
GUARANTY BANK & TRUST
I SAOA
4650 ROYAL VISTA DR
FORT COLLINS CO 80528-0000
DESIGNATED INSURED:
CITY OF FT COLLINS WATER WAY
215 N MASON ST
FORT COLLINS CO 80524-4402
DESIGNATED INSURED:
CITY OF BRIGHTON
22 S 4T" AVE
BRIGHTON CO 80631-2030
ADDITIONAL INSURED:
CITY OF GREELEY
1000 10T" ST
GREELEY CO 80631-3808
f�I �9 [�i ►1�� i � �l t ► b��l ; l� ■�
CITY OF FORT COLLINS
300 LAPORTE AVE
FORT COLLINS CO 80521-2719
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5-1-C-4999249-6
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5-1-C-4999249-6
Shelter Insurance Companies ***MANUAL DEC***
1817 W Broadway
Columbia, MO 65218
'® 1-800-SHELTER
NJiO + NOME IifE
POLICY NUMBER: 5-1-C-4999249-6
CITY OF FT COLLINS W*T-
215 N MASON ST
FORT COLLINS CO 80524-4402
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