HomeMy WebLinkAbout320027 O'NEILL TRUCKING LLC - INSURANCE CERTIFICATE (3)Sent By: DMS ENTERPRISES, INC; 3036971699; Mar-7-07 9:31AM; Page 1/1
A-". CERTIFICATE OF LIABILITY INSURANCES DAz (NNIM) Y"y)
PRODUCER
THIS CERTIFICATE IS ISS ED AS A OP .IIFORMATION
High Country Truck 1n5UrAnce 303-697-6099
%%TER
ONLY AND CONFERS N RIGHTS UPOM THE CERTIFICATE
P.O. BOX 669
HOLDER. THIS CERTIFICATE WES NOT AMENDS EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
MorrlSOn CO 80465
INSURERS AFFORDING COV ORAGE NAIL 8
INSURED
O'NEILL TRUCKING LLC
INSURER A' CORNHUSKER CASUALTY CO, -
12378 N. CO, RD, 7
INSURER, B:
WELLINGTON, CO 80549
INSURERC.
INSURER O:
i INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMFn ABOVE FOR THB POIJC'Y
PERIOD INDICAYEo. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OP 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 TERM$;
EXCLUSIONS AND CONDITIONS OF SUCH
POLII AGGREGATE LIMIT'S SHOWN MAY HAVe BEEN REDUCED BY PAIn CI.AIMS.
POLICY NUMBER FOMEN rDm EFP ECYOVIRATION
CIS
GENERAL LUBNLITY
LACH OCCURRENCE
_M .
f
. ...� CUMMERCIAL CENERAL LNWIUI V
...
E
CLAIMS MADEOCCUR
PTO
REMI
..REMISES -(ES accuron
6 _
MED EXP IAIry wM person)
f
....., .. .. .
T.
PERSONALS ADV INJURY
s
.,.,.__
GENERALAGGREGATE
S _
GEN'L AGGREGATE urArt APPLIES PER:
PRODUCI $ - WWMP AGG
' S 00000000000
Pc'A.IGY P U.X;
A
"TOMOB)LE
LIABILITY
COA800037
2128J2007
2128/2008
COMBINED SI IGLE LIMIT
s 1,000,000
AkLOWNEDAUTOS
PHY/DAM 1,000 D'D
...-_,.,
INJ
SODpe VJJURY
BODIL
f
X
SCHEOULEO AUTOS
IPnr Perron)
HIREDAUTOS
: BODILY INJURY
$
NON -OWNED AUTOS{PvrMvnt)
...
.... _I
PROPFIrtY 11AMAC.F
S
(Pei 6u:ident)
�� AUTO ONLY. EAACCIDENI
s ,-
GARAGE LIABILITY
ANY AUTO'
OTHER THAN EA ACC
S.. ..
IAUTOONLY: AGO
! f
E%CESSAIMBRELLA L1191LITT
r.
;EACH OCCURRENCE
-..RR
2 .....
OCCUR i I CLAIMS MADE
!gCGREC»4TE.
i
f
S
DEDUCTIBLE
I
RETENTION s
i
WORKERS COMPENSATION AND
WCSTATU- OrH-
LIM
EMPLOYERS' LIABILITY
MY F'FIUPHIETORIPARTNF.R)EXECUTIVE
El, EACH ACOIDENT f — -
OFFICEWMEMB9k EXCLUVtLI?
E DISEASE EMPLOY[[ f
IteeoncW
Ii. ..-...C_A. _...
IAL PROVISIONS ebSP
E.L. DISEASE - POLICY UW l i
OTHER
DESCRIPTION OF OPERATIONS I LOCAMNS [VEHICLES I ESCL USNINS ADDED BY ENDORSEMENT) SPEC)µ PROVISIONS
CERTIFICATE HOLDER IS NAMED ADDTIONAL INSURED
CITY OF FT. COLLINS SHOULD ANY OF THE ABOVE DESCRID90 POLICIES BE CANCELLED BEFORE THE EXPIRATION
215 N. MASON ST. DATE THEREOF, THE ISSUING INSUREIE,WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
FT.COLLINS, CO 8052Q NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DD BD SHALL
970-221-6707 1 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON YHE INSURER, RB AGENTS OR
AUTHORIZED REPRESENTATIVE
.® AQORD' CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
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