HomeMy WebLinkAbout112297 VINEY TRUCKING INC - INSURANCE CERTIFICATE (15)acoRD CERTIFICATE OF LIABILITY INSURANCE OP D DATE (MMIDD VYYY)
VINEY-1 OS O5 05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LBN Insurance Agency, LLC FC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
t A I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
1614 Oakridge Drive, Uni
Fort Collins CO 80525
Phone:970-229-9304 Fax:970-229-1398
INSURED
Viney Trucking, Inc. Dba
Duane Vineyy Trucking
2507 Brookhill Rd.
Ft. Collins CO 80524
INSURERS AFFORDING COVERAGE
INSURER A: Pinnacol Assura
INSURER B:
INSURER C:
INSURER D:
INSURER E:
NAIC #
Vw•GMV
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,
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE MMIDDIYY
LT E I TI N
DATE MM/DDM'
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
PREMISES (Ea occurence)
$
COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
$
CLAIMS MADE OCCUR
PERSONAL B ADV INJURY
$
GENERAL AGGREGATE
$
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
POLICY PRO LOC
JECT
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$
ANY AUTO
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
1
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
WC UIH
X TORY LIMITS ER
E.L. EACH ACCIDENT
$100,000
A
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
1963162
06/01/05
06/01/06
E.L. DISEASE - EA EMPLOYEE
$ 100, 000
E.L. DISEASE -POLICY LIMIT
$500,000
It yes, describe under
SPECIAL PROVISIONS below
OTHER
7
DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CITYFCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
CITY OF FORT COLLINS IMPOSE NO OBLIGATION OR LIASIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Attn: Jan - Purchasing Dept
P 0 BOX 580 REPRESENTATIVES.
FORT COLLINS CO 80521 AU RIZ REPREB
ACORD 25
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.