HomeMy WebLinkAboutHARSOOK EQUIPMENT - INSURANCE CERTIFICATEACORn,. CERTIFICATE OF LIABILITY INSURANCE OP ID Cl DATE(MMIDD/YYYY)
WNENE-1 06 02 08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Monroe & Monroe Insurance Agen HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2921 Galleria Dr., Suite 102 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Arlington TX 76011 -
Phone: 817-640-5035 Fax: 817-640-0131 I INSURERS AFFORDING COVERAGE 44 NAIC #
INSURED INSURERA Mid -Continent Casualty Co.
INSURER B
Hartsook Equipment & Pump Service,wsuRERc Inc. L_
1640 W. 18th Street INSURER
Cheyenne WY 82001 __.
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.
DD,
LTR NSR TYPE OF INSURANCE POLICY NUMBER I POLICY EFFECTIVE POLICY EXPIRATION
DATE MMI00/YY DATE [MMIDD/YYj LIMITS
GENERAL LIABILITY
EACH OCCURRENCE_ $S,000,OOO
A XCOMMERCIAL GENERAL LIABILITY04GL722498
06 Ol O$
DMAGE70ED
O6 OS O9 PREMISES (E. $lOOi OOO
CLAIMS MADE X OCCUR
MED EXP (Any one person) $ Q
X I P_L_Ofessional Liab
PERSONAL B ADV INJURY $ 11000, 000
X Pollutio
n On Llab
GENERAL AGGREGATE r$2,000L000
GEN'L AGGREGATE LIMITAPPLIES PER:
PRODUCTS COMP/OP AGG $ 2 T OOO, OOO
POLICY ' JECOT I LOG
_— — - - -
AUTOMOBILE LIABILITY
-- COMBINED SINGLE LIMIT
�
ANY AUTO i (Ea accident)
F$
ALL OWNED AUTOS
,BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY
NON -OWNED AUTOS (Per accident) $
-_-- - --- PROPERTY DAMAGE $
(Per accident)
GA _ GE LIABILITY
AUTO ONLY EA ACCIDENT
$
ANY AUTO
i
OTHER THAN EA ACC
$
AUTO ONLY. AGG
$—
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE.
AGGREGATE
$
$
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION AND
ATU- TH-
EMPLOYERS' LIABILITY
�TCIRY LIMITS _ ER
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERIMEMSER EXCLUDED?
E.L. EACH ACCIDENT $
Hyes,describe under
E.L. DISEASE EA EMPLOYEE $
SPECIAL PROVISIONS below
E�EASE POLICY LIMIT $
OTHER
A Installation Fltr 04IM28078 06/01/08 06/01/09 per loc 250000
• Bailse/Caro 04IM28078 06/01/08 06/01/09i Limt 100,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
reoYI!el a u^, ..r
CFORTCO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
The City OF Fort Collins PO Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins CO 80522 REPRESENTATIVES.
AViFp1ZED R, SENTA'
25 (2001/08)
1989
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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