HomeMy WebLinkAboutBURGENER TRUCKING - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID R DATE (MMIDD/03
BURGE-1 06 02 03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Linden/Bartels & Noe Agency FC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
d D ' U 'i t A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
1614 Oakri ge rive, n
Fort Collins CO 80525
Phone:970-229-9304 Fax:970-229-1398
Burgener Trucking, Inc.
& Three C's, LLC
1801 N. Overland Trail
Ft. Collins CO 80521
COVERAGES
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: EMC Insurance Companies
INSURER B: Deep South of Colorado
INSURERC: Pinnacol Assurance
INSURER D: _
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.
N*K
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY CTIVE
DATE MWD
POLICY EXPIRATION
DATE MM/D
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 , 000 , 000
PREMISEs(Eaoc %Ice)
$100,000
A
X COMMERCIAL GENERAL LIABILITY
2X2503602
03/18/03
03/18/04
MED EXP (Any one person)
s5,000
CLAIMS MADE 1K OCCUR
PERSONAL B ADV INJURY
$ 1,000,000
BLANKET ADDITIONAL
$2,000,000
INSUREDS APPLY
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMPIOP AGG
$1,000,000
POLICY PROJECT LOC
B
AUTOMOBILE
LIABILITY
ANY AUTO
DMA000001674
03/18/03
03/18/04
COMBINED SINGLE LIMIT
(Ea accident)
$ 1 , 000 , 000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
E
BLANKET ADDITIONAL
INSUREDS APPLY
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
E
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
VY
X ITORY LIMITS ER
E.L. EACH ACCIDENT
s500,000
C
EMPLOYERS'
IETORILIABILITY
ANYCERIMEMB RIPARLUDEDXECUTIVE
OFFICER/MEMBER EXCLUDED?
3049048
06/01/03
06/01/04
E.L. DISEASE - EA EMPLOYEE
$ 5OO , OOO
SIXyECde PRO wider
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$500 000
OTHER
A
Physical Damage
2X2327604
03/16/03
03/16/04
COMP 500
COLL 500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate holder is named as Additional Insured as respects the General
Liability.
CERTIFICATE HOLDER GAI Lvr LLF111UW
CITYFCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
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
CITY OF FORT COLLINS IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
ATTN: JOHN STEPHEN
256 W. MOUNTAIN AVE. REPRESENTATIVES.
FORT COLLINS CO 80521 AUTHORIZED REPRESENTATIVE 1
25 (2001/08)