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Home My WebLink About150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (12)4' Policy Issued By Shelter General Insurance Co. Columbia, MO 65218-0001 ,a 1-800-SHELTER Notice to the Additional Insured: Your interest will be continuous until cancellation notice is mailed to you. (Item #1) Named Insured: j WALSH CONSTRUCTION INC 8139 OPEN VIEW PL LOVELAND CO 80537-9481 Policy Declarations and Schedule Motor Carrier Coverage Addl. Interest or Addl. Insured Copy Agent SHELTER INSURANCE COMPANIES (05-OE246-10) 4025 AUTOMATION WAY UNIT C4 FORT COLLINS CO 80525 PHONE: 970-377-2070 Policy Number: 5-1-C-4999249-6 Effective Date: November 03, 2011, 11:38 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 It #3) Vehic_ le Year Make/Model Vehicle ID , 1994 INTER#AAAA3527 1HTSOPPNORH578074 S N O N 0 Bodily Injury and Property Damage 67 $1,000,000 Limit $169.17- Collision 67 $500 Deductible $73.46 Comprehensive 67 $500 Deductible $42.29 CO Uninsured Motorists Cov Limits 67 $250,000 Per Person CA 21 50 01 11 $22.26 Split Uninsured Motorist (Coverage) 67 $500,000 Per Accident CA 21 02 11 06 Received For This Reissue: $414.00 Additional Insured CITY OF GREELEY CA 20 01 03 06 Loss Payable Clause CA 99 44 12 93 Designated Insured CITY OF FORT COLLINS CA 20 48 02 99 Designated Insured CITY OF BRIGHTON CA 20 48 02 99 Designated Insured CITY OF FT COLLINS WATERS WAY CA 20 48 02 99 Designated Insured CITY OF LONGMONT PUBLIC WORKS CA 20 48 02 99 Designated Insured CITY OF FORT COLLINS CA 20 48 02 99 Common Policy Conditions (Information May Continue on Back) IL 00 1711 98 n By (For Office Use Only) Countersigned y P.C. RATE CLASS 16A TERRITORY 3 TERM 6 / H.O. CODE 414.00 09142011 DATE ISSUED: 11042011 COST SYMBOL F PACKAGE -CD 1 TIER: N/A A-2.54-A I Policy Issued By a Shelter General Insurance Co. Columbia, MO 65218-0001 1 800 SHELTER Notice to the Additional Insured: Your interest will be continuous until cancellation notice is mailed to you. (Item #1) Na'med Insured. WALSH CONSTRUCTION INC 8139 OPEN VIEW PL LOVELAND CO 80537-9481 Policy Declarations and Schedule Motor Carrier Coverage Addl. Interest or Addl. Insured Copy Agent SHELTER INSURANCE COMPANIES (05-OE246-10) 4025 AUTOMATION WAY UNIT C4 FORT COLLINS CO 80525 PHONE: 970-377-2070 Policy Number: 5-1-C-4999249-7 Effective Date: November 03, 2011, 11:43 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 (Item 0 =r Vehicle Year ` Make/Model Vehicle ID 1987 TAGALTAGALONG 119187 Bodily Injury 67 $1,000,000 Received For This Reissue: $42. NONE 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 Designated Insured CITY OF FORT COLLINS CA 20 48 02 99 Common Policy Conditions IL 00 17 1198 CO Concealment, Misrepresent or Fraud IL 01 69 09 07 CO Changes- Cancellation and Nonrenewal IL 02 28 09 07 Nuclear Energy Liability Exclusion IL 00 21 09 08 Amendatory Endorsement A-672.3-A Colorado Changes CA 01 13 01 11 (Information May Continue on Back) (For Office Use Only) P.C. RATE CLASS 16A TERRITORY 3 TERM 12 H.O. CODE 114.00 03162011 DATE ISSUED: 11042011 COST SYMBOL B PACKAGE -CD 1 TIER: N/A Countersigned By A-2.54-A 9IR=' Policy Issued By Shelter General Insurance Co. Columbia, MO 65218-0001 ;� ^� 1-800-SHELTER Notice to the Additional Insured: Your interest will be continuous until cancellation notice is mailed to you. (Item #1) Named Insured. WALSH CONSTRUCTION INC 8139 OPEN VIEW PL LOVELAND CO 80537-9481 IIIIWRIIU�1911111 - Policy Declarations and Schedule Motor Carrier Coverage Add]. Interest or Add]. Insured Copy Agent = SHELTER INSURANCE COMPANIES (05-OE246-10) 4025 AUTOMATION WAY UNIT C4 FORT COLLINS CO 80525 PHONE: 970-377-2070 Policy Number: 5-1-C-4999249-6 Effective Date: November 03, 2011, 11:38 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 Aft em'#3) Vehicle Year -Make/Model - Vehicle ID 1994 _ INTER #AAAA3527 1 HTSDPPNORH578074 Bodily Injury and Property Damage 67 $1,000,000 Limit $169.17 Collision 67 $500 Deductible $73,46 Comprehensive 67 $500 Deductible $42.29 CO Uninsured Motorists Cov Limits 67 $250,000 Per Person CA 21 50 01 11 $22.26 Split Uninsured Motorist (Coverage) 67 $500,000 Per Accident CA 21 02 11 06 Received For This Reissue: CITY OF GREELEY $414.00 Loss Payable Clause CA 99 44 12 93 Designated Insured CITY OF FORT COLLINS CA 20 48 02 99 Designated Insured CITY OF BRIGHTON CA 20 48 02 99 Designated Insured CITY OF FT COLLINS WATERS WAY CA 2048 02 99 Designated Insured CITY OF LONGMONT PUBLIC WORKS CA 20 48 02 99 Designated Insured CITY OF FORT COLLINS CA 20 48 02 99 Common Policy Conditions (Information May Continue on Back) IL 0017 11 98 By (For Office Use Only) Countersigned Y P.C. RATE CLASS 16A. TERRITORY 3 TERM 6 I H.O. CODE 414.00 09142011 DATE ISSUED: 11042011 COST SYMBOL F PACKAGE -CD 1 TIER: N/A A-2.54-A 0 S N O N 0 'a Policy Issued By Shelter General Insurance Co. Columbia, MO 65218-0001 l 1-800-SHELTER Notice to the Additional Insured: Your interest will be continuous until cancellation notice is mailed to you. (Item #1) Named Insured: WALSH CONSTRUCTION INC 8139 OPEN VIEW PL LOVELAND CO 80537-9481 i�i soli Policy Declarations and Schedule Motor Carrier Coverage Addl. Interest or Addl. Insured Copy :A - SHELTER INSURANCE COMPANIES (05-OE246-10) 4025 AUTOMATION WAY UNIT C4 FORT COLLINS CO 80525 PHONE: 970-377-2070 Policy Number: 5-1-C-4999249-7 Effective Date: November 03, 2011, 11:43 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 TAGALTAGALONG 67 Received For This Reissue: NONE 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 Designated Insured CITY OF FORT COLLINS CA 20 48 02 99 Common Policy Conditions IL 00 17 11 98 CO Concealment, Misrepresent or Fraud IL 01 69 09 07 CO Changes- Cancellation and Nonrenewal IL 02 28 09 07 Nuclear Energy Liability Exclusion IL 00 21 09 08 Amendatory Endorsement A-672.3-A Colorado Changes CA 01 13 01 11 (Information May Continue on Back) (For Office Use Only) P.C. RATE CLASS 16A TERRITORY 3 TERM 12 H.O. CODE 114.00 03162011 DATE ISSUED: 11042011 COST SYMBOL B PACKAGE -CD 1 TIER: N/A Countersigned By JA& ! f S S 0 N 0 W A-2.54-A R' Policy Issued By I Shelter General Insurance Co. Columbia, MO 65218-0001 1-800 SHELTER Notice to the Additional Insured: Your interest will be continuous until cancellation notice is mailed to you. I (Item #1) Narned insured: WALSH CONSTRUCTION INC 8139 OPEN VIEW PL LOVELAND CO 80537-9481 �u ui i Policy Declarations and Schedule Motor Carrier Coverage Addl. Interest or Addl. Insured Copy SHELTER INSURANCE COMPANIES (05-OE246-10) 4025 AUTOMATION WAY UNIT C4 FORT COLLINS CO 80525 PHONE: 970-377-2070 Policy Number: 5-1-C-4999249-6 Effective Date: November 03, 2011, 11:38 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 (Item 0) Vehicle Year Make/Model Vehicle ID 1994 INTER 4fAAAA3527 1 HTSDPPN0RH578074 Collision 67 $500 Deductible $73.46 Comprehensive 67 $500 Deductible $42.29 CO Uninsured Motorists Cov Limits 67 $250,000 Per Person CA 21 50 01 11 $22.26 Split Uninsured Motorist (Coverage) 67 $500,000 Per Accident CA 21 02 11 06 Received For This Reissue: $414.00 Additional Insured CITY OF GREELEY CA 20 01 03 06 Loss Payable Clause CA 99 44 12 93 Designated Insured CITY OF FORT COLLINS CA 20 48 02 99 Designated Insured CITY OF BRIGHTON CA 20 48 02 99 Designated Insured CITY OF FT COLLINS WATERS WAY CA 20 48 02 99 Designated Insured CITY OF LONGMONT PUBLIC WORKS CA 20 48 02 99 Designated Insured CITY OF FORT COLLINS CA 20 48 02 99 Conditions (Information May Continue on Back) (For Office Use Only) P.C. RATE CLASS 16A TERRITORY 3 TERM 6 H.O. CODE 414.00 09142011 DATE ISSUED: 11042011 COST SYMBOL F PACKAGE -CD i TIER: N/A 17 11 98 Countersigned By 0 S N O N m A-2.54-A