HomeMy WebLinkAbout150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (7)r' Policy Issued By
I
Shelter General Insurance Co.
Columbia, MO 65218-0001
wos 1-800-SHELTER
Notice to the Additional Insured: Your interest will be
continuous until cancellation notice is mailed to you.
(Item #1) Nanedlnsured:
WALSH CONSTRUCTION INC
8139 OPEN VIEW PL
LOVELAND CO 80537-9481
I�IIII � III
Policy Declarations and Schedule
Motor Carrier Coverage
Addl. Interest or Add]. Insured Copy
Policy Number: 5-1-C-4999249-7 Effective Date: March 17, 2011, 12:01 A.M. Central Time
Policy Form Number: CA 00 20 03 10 Expiration Date: March 17, 2012, 12:01 A.M. Central Time
Policy and Endorsements are available upon request
1987
Bodily Injury and Property Damage
TAGALTAGALONG
67
119187
$1,000,000
Total for Term (This is Not a Bill): $114.00
Additional Insured CITY OF LONGMONT, PUBLIC WORKS
CA 20 01 03 06
Designated Insured CITY OF LONGMONT
CA 20 48 02 99
Designated Insured CITY OF FT COLLINS WATERS WAY
CA 20 48 02 99
Designated Insured CITY OF GREELEY
CA 20 48 02 99
Amendatory Endorsement
A-672.3-A
Colorado Changes
CA 01 13 01 11
Common Policy Conditions
IL 00 17 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)
RENEW RATE CLASS 16A TERRITORY TERM 12
H.O. CODE 114.00 10212010 DATE ISSUED: 03162011
COST SYMBOL B PACKAGE -CD 1 TIER: N/A
Countersigned By 'R� \ `
A-2.54-A