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A91h AbIlL <br /> ACORD OP ID NR <br /> DATE IDD/YM) <br /> - CERTIFICAW OF LIABILITY INSURANIF CGRS- ULU— <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> LBN Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 4848 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Johnstown CO 80534 <br /> Phone: 970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: ACE Westchester <br /> INSURER 8: ACE A.-i... I...-nc. Company <br /> C G R S Inc. INSURER C: Pinnacol Assurance <br /> PO Box 1489 INSURER D: St. Paul T--l... 1--.... <br /> Ft. Collins CO 80522 <br /> I INSURERJE: Arqonaut Insurance <br /> COVERAGES <br /> THE POLICIES'OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> POLICY EFFECTIVE POLICY <br /> N <br /> TYPE OF INSURANCE DATE(MM/DD/YY) RATE(4M <br /> N AUL <br /> LTR INSR POLICY NUMBER LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br /> LJAMAU�-I U KEN I I-D­— <br /> A X COMMERCIAL GENERAL LIABILITY G22071798-003 03/01/08 03/01/09 PREMISES(Ea orcurence) s50,OOO <br /> —7 CLAIMS MADE OX,OCCUR MED EXP(Any one person) _ $5,000 <br /> X POLLUTION/PROF B— ADD'L 1:NS E-31110 PERSONAL&ADV INJURY $1,000,000 <br /> CLAIMS MADE WAVER -EKV3101 (05-04) GENERAL AGGREGATE s2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG s2,000,000 <br /> PRO- F� I <br /> I x I POLICYLOC F7 JECT En!p Ben -1-'000 0 0 <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE lW"" <br /> 000,0(P('? <br /> ANvA-�-' 64 <br /> 7 <br /> A <br /> A <br /> X Bianket A-1 <br /> ROPEJ2IYDWAr:-4= <br /> X iElanket Wadver (Per accident) <br /> GARAGE LiAB!"jTV AUI� ONLY E-Ar- <br /> -HER T HAJ j�A(-',f <br /> AU'0 ONLY <br /> ACSG , ' <br /> EXCESS/UMBRELLA LIABILITY <br /> EACH OCCURREICE <br /> CLAIMS MADE I <br /> OCCUR ❑ AGGREGATE <br /> $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND X TORY LIMITS X <br /> rO7Fr-- <br /> C EMPLOYERS'LIABILITY 4029480 CO 01/01/08 01101/09 E.L.EACH ACCIDENT ER $1000000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> E OFFICER/MEMBER EXCLUDED? WC47678823233- CA E.L.DISEASE-EA EMPLOYEE $1000000 <br /> If yes,describe under <br /> SPECIAL PROVISIONS below E.L.DISEASE-POLICYI.IMIT $1000Q00 <br /> OTHER <br /> D Equipment Floater BP02050277 03/16/08 03/16/09 Rented/ $200,000 <br /> 1 - Leased $500 Ded <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEE I SPECIAL PROVISIONS <br /> Certificate holder is named as additional insured with respects to the <br /> general liability, auto liability and the contractors pollution per <br /> referenced forms. <br /> CERTIFICATE HOLDER CANCELLATION <br /> FORINFP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br /> For Information Purposes NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> Only IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTbjR RES!&jZr 07 <br /> IAA4_ <br /> ACORD 25(2001108) 0 ACORD CORPORATION 1988 <br />