HomeMy WebLinkAboutA B TRUCKING - INSURANCE CERTIFICATE (2)08/01/00
CERTIFICATE OF INSURANCE
THIS IS TO CERTIFY THAT we have issued to the Insured a policy of insurance which provides coverage as described below. THIS
CERTIFICATE OF INSURANCE DOES NOT IN ANY WAY AMEND,EXTEND,ALTER, OR VARY THE COVERAGE AFFORDED BY THE
POLICY OR POLICIES REFERRED TO HEREIN. UNTIL
ITEM 1. Policy Number BA2 4 8 0 0 5 6- 5 7- 0 2 Effective Date 0 7/ 14 / 0 0 Expiration Date CANCELLED
ITEM 2. Name of Insured ARNOLD & BEVERLY BURNS DBA: A & B TRUCKING
ITEM3. Addressof Insured 420 E. 57TH #55 LOVELAND CO 80538
ITEM 4. Name and Address of Certificate Holder
f 71734
CITY OF FORT COLLINS
256 W. MOUNTAIN AVE.
PO BOX 580
FORT COLLINS CO 80524
L J
ITEM 5. Description of Insurance
If the policy is cancelled, we will endeavor to
give written notice to the person tp whorOlthis
certificate is issued, but failure to give such
notice will impose no obligation: or liability
upon us.
POLICY
COVERAGE
LIMITS OF LIABILITY
Bodily Injury/Property Damage
Combined Single Limit
$1 . 0 0 0 . 000
Each Person
$
Automobile
Bodily Injury
Each Accident
$
Liability
Property Damage
Each Accident
$
PERSONAL INJURY PROTECTION
Each Unit
$ NOCVG
Cargo
Less Deductible
$
Aggregate
$
Automobile
Stated Amount or ACV
PER SCHEDULE
$
Physical
Collision
Less Deductible
09 FILE WITH
Damage
Specified Perils
Less Deductible
$COMPANY
Comprehensive
Less Deductible
$ (BA4)
Other
$
Coverage
$
ITEM 6. Covered Autos Due to periodic changes in Schedule
of Vehicles we do not furnish specific descriptions.
You are listed as a certificate holder on this policy.
ITEM 7. Description of Operations: ® Truckmen - Primary Liability; ❑ Non -trucking Liability only; ❑ Other (Explain)
This certificate shall not be valid until countersigned by a duly authorized representative of
WILSHIRE INSURANCE COMPANY
P.O. BOX 7006
LANCASTER, CALIFORNIA93539-7006
A
G INSURANCE MANAGEMENT, INC.
E 6075 EAST 60TH AVENUE
N COMMERCE CITY CO 80022
T
Authorized Representative
oB BA 2 (6/91) ORIGINAL
Countersignature
POLICY NUMBER: BA2480056 WA 143 05 99
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTOMOBILE COVERAGE PART
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Endorsement Effective: 07/14/00
Countersigned By:
t�
Named Insured: Arnold & Beverly Burns/f
DBA: A & B Trucking
(Authorized Representative)
(if no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.
Who Is An Insured (Section II, Part 1) of the policy is amended to include as an insured the person or organization shown
in the schedule as an insured but only with respect to liability arising out of the operation of "covered autos" owned,
maintained or used by the Named Insured, as listed in the Declarations.
Schedule of person(s) or organization(s):
71734
City Of Fort Collins
256 W. Mountain Ave.
PO Box 580
Fort Collins, CO 80524
This endorsement shall take effect at 12:01 o'clock A.M., standard time at insured's address and shall terminate
simultaneously with this policy.
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or
declarations of the undermentioned Policy other than as above stated.
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