HomeMy WebLinkAbout206064 ARNOLD BURNS DBA A & B TRUCKING - INSURANCE CERTIFICATE (2)D CERTIFICATE OF LIABILITY INSURANCE OPID G DATE (MNvoonvvr)
ACORABTRUCI 09 05 07
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HUB Transportation (CO)
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
6075 E. 60th Avenue
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Commerce City CO 80022
Phone: 800-880-0975 Fax:303-287-2311
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
INSURERA: Wilshire Insurance Company
INSURER B'.
A & B Trucking
Arnold & Beverly Burns dba
420 East 57th #55
Loveland CO 80538
INSURER
INSURER D.
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS POLICY tFFECTIVE POLICY EXPIRATION
LTRIINSRO TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE IMMi LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurence)
$
CLAIMS MADE L�] OCCUR
MED EXP (Any one person)
$
PERSONAL B ADV INJURY
$
GENERAL AGGREGATE
$
SENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMPIOPAGG
$
PRO-
POLICY 7 ECT OC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$1r 000,000
BODILY INJURY
(Per person)
$
A
ALL OWNED AUTOS
SCHEDULED AUTOS
BA2480056
07/08/07
07/08/08
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - FA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: ADS
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
TORY LIMITS ER
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
E.L. EACH ACCIDENT
8
E. L. DISEASE, EA EMPLOYEE
$
OFFICERIMEMBER EXCLUDED?
If yes describe under
SPECIAL PROVISIONS below
E.L. DISEASE POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
The Additional Insured endorsement is on file with the Insurance Company
with respects to Auto Liability coverage.
L,CM I II -ILA I C r1 VLUCR
City of Fort Collins
Purchasing Dept.
PO Box 580
Fort Collins CO 80524
CITYFO2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO!
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
K-1
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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.