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HomeMy WebLinkAboutT J TRUCKING - INSURANCE CERTIFICATE (2)CERTIFICATE OF INSURANCE This certificate of insurance is NOT an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. 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 which may substantially limit coverage. Where reference is made to an Aggregate Limit, those limits are Company's maximum liability under the Policy for the entire policy period regardless of the number of insureds, claimants or occurrences. Certificate is issued by Insured's Representative. Additional insured and other endorsements may only be authorized by the Company or its appointed General Agent. Date 07/26/2005 NAME OFINSURED T & J Trucking, Inc P.O.ADDRESS 8739 N. Taft Hill Rd Ft. Collins CO 80524 Insurance Company Name: Columbia Insurance Company Insurance Company Address: 3024 Harney Street • Omaha, Nebraska • 68131-3580 POLICY NUMBER KINDS OF INSURANCE LIMITS EFFECTIVE EXPIRES COMMERCIAL GENERAL LIABILITY ❑ Occurrence Form ❑ Claims -Made Form Coverages ❑ Premises -Operations ❑ Products/Completed Operations ❑ Other (Specify) N/A General Aggregate Limit $ N/A Products -Completed Operations Aggregate Limit $ N /A Personal & Advertising Injury Limit $ N/A Each Occurrence Limit $ N/A Fire Damage Limit (Any One Fire) $ N/A Medical Expense Limit (Any One Person) $ N/A Aggregate Limit on Claims Expenses $ N/A Manuscript endorsements applicable AUTOMOBILE LIABILITY Bodily Injury Each Person $ N/A 05/26/2005 05/26/20 71TRN308999 Each Accident $ N/A 12:01 A.M. 12:01 A. Property Damage Each Accident $ N/A Bodily Injury and Property Damage Combined Single Limit $ 1, 000, 000 GARAGE LIABILITY Bodily Injury and Property Damage Auto Only Other than Auto Combined Single Limit $ N/A $ N/A N/A Aggregate Limit s Garagekeepers Insurance ❑ Legal Liability $ N A ❑ Direct Excess $ N A ❑ Direct Primary $ N A EXCESS LIABILITY ❑ Automobile ❑ General Liability Name of Primary Insurer. Primary Limits $ N/A N/A Excess Limits $ N/A General Aggregate Limit $ N/A ❑ Aggregate Limit inclusive of Claims Expenses N/A N/A Employer's Liability $ N/A N/A Other N/A DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES In the event of any material change in or cancellation of said policies, the Insured's Representative issuing this Certificate intends to, but is not obligated to, notify the parry to whom this Certificate is addressed of such change or cancellation. The COMPANY undertakes no responsibility by reason of any failure of the Insured's Representative to provide such notification. This Certificate issued to: This Certifica 'ssued by: . City of Fort Collins By PO Box 580 Lsifrance AgeAgerWy, Inc If Fort Collins, CO 80522-0580 Name of Insured's Repres tative M•5044b (06/2002) M M. AC(M, CERTIFICATE OF LIABILITY INSURANCE °ATE(/26/MMID°""""' O2005 S PRODUCER (970)223-0924 FAX (970)267-2231 BW Insurance Agency, Inc. 1075 W Horsetooth Rd, Ste 100 Fort Collins, CO 8OS26 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED T & 7 Trucking, Inc. 8739 N. Taft Hill Rd. Fort Collins, CO 80524 INSURERA'. Columbia In/Swett Ins Mngrs INSURER B: NsuRER c. 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. INSR DO' TYPO OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED E $ MED EXP (Any one person) PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GEHL AGGREGATE LIMIT APPLIES PER: POLICY PRO- 1-1 LOC JECT PRODUCTS - COMPIOP AGG $ A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS 71TRN308999 05/26/2005 OS/26/2006 COMBINED SINGLE LIMIT (Ea accdent) $ 1, 000 DD BODILY INJURY (Per person) $ X X BODILY INJURY (Per accident) E X PROPERTY DAMAGE (Per accident) $ GARAGE LABILITY ANY AUTO AUTO ONLY- EA ACCIDENT $ OTHER THAN EAACC AUTO ONLY: AGG $ $ EXCESSIUMBRELLA LABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION E EACH OCCURRENCE $ AGGREGATE E $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC STATU-,RY I OTH- FR E.L. EACH ACCIDENT $ E.L. UISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Fort Collins 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, attn : James O'Neil BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LABILITY PO BOX 580 OF ANY KIND UP21 THE INSURER, ITS AGENTS OR REPRESENTATIVES. Fort Collins, CO 80S22—OSSO AUTHORIZED REFI0gftTATrVE ��' Rosemar ACORD 25 (2001/08) FAX: (970)224-6134 ©ACOIOCORPORATION 1988 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 (2001105)