HomeMy WebLinkAbout112297 VINEY TRUCKING INC - INSURANCE CERTIFICATE (2)4CORo. CERTIFICATE OF LIABILITY INSURANCE OP ID JL DATE(MMIDD/(YYY)
VINEY-1 1 05 13 O8
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LBN Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4848 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Johnstown CO 80534
Phone: 970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: P±nnacol Assurance
INSURER B:
Viney Trucking, Inc. Dba--------_-- -- ----- — -- --------
Duane Viney Trucking INSURER C:
2507 Brook iINSURER D
CO 80'.
Ft. Collins CO 80524 _--
INSURER E:
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.
INSRADD' -- "'" __ ""'""--'- --'- POLICY EFFECTIVE POLICY EXPTRHTION
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDO/YY DATE MMIDOIYY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
COMMERCIALGENERALLIABILITY
CLAIMS MADE [1 OCCUR
-OAMAGETOFENTED-
PREMISES (Ea occurence)
'- _ ""'--
$
MED EXP (Any one person)
$
PERSONAL &ADV INJURY
$
GENERAL AGGREGATE
$
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OPAGG
$
POLICY PRO-
ECT OC
-- -'-"'
--
AUTOMOBILE
LIABILITY
ANY AUTO
nt51NGLE LIMIT
COMBINEa accident)
(E
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Par person)
$
HIRED AUTOS
--
NON -OWNED AUTOS
BODILY INJURY
(Per accldenq
$
- -
PROPERTY DAMAGE
(Per accident)
$
— -- ---
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
DEDUCTIBLE-
- -___--
RETENTION
is
A
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITV ANY PROPRIETORIPARTNERIEXECUTIVE
1963162
06/01/08
06/01/09
X TWO LIMITS E_R_
E.L. EACH ACCIDENT
$1001 000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
B.<.x'.R of sueROcmr¢o
_._._.._._
E. L. DISEASE EA EMPLOYEE$
_
100, 000
E.L. DISEASE -POLICY LIMIT
$50D 000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I 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
CITY OF FORT COLLINS
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $0 SHALL
Attn: Jan - Purchasing Dept IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P O BOX 580 REPRESENTATIVES.
FORT COLLINS CO 80521 AUT IWAEVRESEqqrATIVVE
ACORD 25 (2001/08) ---- -- -- n ArnRn rnP1RnRATInM Iona
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.
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