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Home My WebLink AboutContract - Sam & Sons Trucking - BID - 9945 Hauling Services 2024DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 3/27/2024 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 Form_SCTNID_CTGRY.XX0316ACORD25_ACORD <docindex><index>ACORD</index></docindex> BDF_PCA CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: PHONE (A/C, No, Ext): FAX (A/C, No): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSR LTR ADDL INSD SUBR WVDTYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY OTHER: PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON-OWNED AUTOS ONLY UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N / A POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYY)(MM/DD/YYYY)LIMITS $ $ $ $ $ $ $ EACH OCCURRENCE DAMAGE TO RENTED MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG PREMISES (Ea occurrence) $ $ $ $ $ COMBINED SINGLE LIMIT PROPERTY DAMAGE BODILY INJURY (Per person) (Ea accident) BODILY INJURY (Per accident) $ $ $ AGGREGATE EACH OCCURRENCE E.L. EACH ACCIDENT INSURED $ $ $E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE PER STATUTE OTH- ER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. (Per accident) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. progressivecommercial@email.progressive.com 03/06/2024 1-800-444-4487 SAM & SONS TRUCKING LLC DBA: SAM & SONS TRUCKING 2500 E HARMONY RD LOT 402 FORT COLLINS, CO 80528 City of Fort Collins PO Box 580 Fort Collins, CO 80522 Progressive Commercial Lines Customer and Agent Servicing 325049626509578009D030624T225607 AMERICAN FAMILY BRKR 6000 AMERICAN PKWY, MADISON, WI 53783 Artisan and Truckers Casualty Company 10194 A X X X 08123606YY 09/05/2023 09/05/2024 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 A X 08123606YY 09/05/2023 09/05/2024 1,000,000 A 08123606NN 09/05/2023 09/05/2024 See ACORD 101 for additional coverage details.$ 100,000 100,000 500,000 X X DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 Form_SCTNID_CTGRY.XX0108ACORD101_ACORD <docindex><index>ACORD</index></docindex> BDF_PCA AMERICAN FAMILY BRKR 08123606 Artisan and Truckers Casualty Company 10194 SAM & SONS TRUCKING LLC DBA: SAM & SONS TRUCKING 2500 E HARMONY RD LOT 402 FORT COLLINS, CO 80528 09/05/2023 AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY POLICY NUMBER CARRIER NAIC CODE NAMED INSURED EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:25 FORM TITLE:Certificate of Liability Insurance 1 1 Additional Coverages Insurance coverage(s) Limits…………………………………………………………………………………………………………………………………………………………………………………… Uninsured/Underinsured Motorist $100,000 Combined Single Limit Description of Location/Vehicles/Special Items Scheduled autos only…………………………………………………………………………………………………………………………………………………………………………………… 1997 PTRB 1XP5DB8X2VD414788379 Medical Payments $5,000 …………………………………………………………………………………………………………………………………………………………………………………… 1993 KENWORTH 2XKADR9X0PM584608CONSTRUCTION Medical Payments $5,000 …………………………………………………………………………………………………………………………………………………………………………………… 2020 Jet 5JNSS4128LH000116Trailer Comprehensive $2,500 Ded Collision $2,500 Ded …………………………………………………………………………………………………………………………………………………………………………………… 1997 PETERBILT 1XP5DB8X4VD426568379 Medical Payments $5,000 …………………………………………………………………………………………………………………………………………………………………………………… 2018 RAM 3C6UR5FL8JG3424352500 Medical Payments $5,000 Comprehensive $1,000 Ded Collision $1,000 Ded …………………………………………………………………………………………………………………………………………………………………………………… 1996 PETERBILT 1XP5DB8X4TD393505379 Medical Payments $5,000 …………………………………………………………………………………………………………………………………………………………………………………… 1997 PETERBILT 1XP5DR8X6VN429443379 Medical Payments $5,000 …………………………………………………………………………………………………………………………………………………………………………………… 2030 Non-owned Attached Trailer …………………………………………………………………………………………………………………………………………………………………………………… 2017 RAM 1C6RR7KT9HS8241771500 Medical Payments $5,000 Comprehensive $1,000 Ded Collision $1,000 Ded …………………………………………………………………………………………………………………………………………………………………………………… 2007 KENWORTH 3WKDDB9X77F205331CONSTRUCTION Medical Payments $5,000 …………………………………………………………………………………………………………………………………………………………………………………… 1997 TRLK 1TKS04222VM106991 Trailer …………………………………………………………………………………………………………………………………………………………………………………… 2011 INTERNATIONAL 3HSCHAPR7BN3700729900 Medical Payments $5,000 Liability coverage may not apply to all scheduled vehicles. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760 DocuSign Envelope ID: 90B3D8EA-ED3F-41DE-91E2-5224BBC21760