HomeMy WebLinkAbout112297 VINEY TRUCKING INC - INSURANCE CERTIFICATE (13)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID D DATE (MM/DD YYYY)
VINEY-1 05 05 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
1614 Oakridge Drive, Unit A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80525
Phone: 970-229-9304 Fax:970-229-1398 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Plnnacol Assurance
INSURER BB
Viney Trucking, Inc. Dba INSURER C:
Duane Vineyy Trucking
2507 Brookhlll Rd. INSURER D:
Ft. Collins CO 80524
INSURER E:
GUVEKAUE5
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.
INUK
ADD'
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLTR
DATEYOLICY MM/DD/YY E
EXPIRATION
MM/DD
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F—IOCCUR
EACH OCCURRENCE
$
PREMISES (Ea occurence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
JECT
PRODUCTS - COMP/OP AGG
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
E
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
E
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EXCESS/UMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
E
$
$
A
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
ANY PROPRIETORlPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
1963162
06/01/05
06/01/06
WC 9TATO-F—TOTIP17
!I. TORY LIMITS I ER
E.L. EACH ACCIDENT
$100, 000
E.L. DISEASE - EA EMPLOYEE
$ 100 , 000
E.L. DISEASE -POLICY LIMIT
$500 000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
(:FRTIFI(:ATP Mnl 11FR rANrr-I I ATInk!
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
Attn: Jan - Purchasing Dept
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P 0 BOX 580
REPRESENTATIVES.
AU RIZ REPRES
FORT COLLINS CO 80521
ACORD 25 (2001108) V AGUKU UUKh'UKA I IUN T `J99
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.
ACORD 25 (2001/08)