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Home My WebLink AboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCEPIR99REff1Y ' Application for Insurance 4-0 Please review r sign where Policy number: 05LE BOYS Named Insured: UiTLE BOYSTRUGKINS, LLC indicated, and return March 25,2009 Page 1 of i 2 Policy and premium information for policy number 05351504.0 ............................................................................................................................................................................. insurance company: Artisan and Truckers Casualty Co - P.O. BOX 94739 Cleveland, OH 44101 ........................................................................................................................................................................... Ayent: !OHN NOLAND FUSA/NOLAND 10HN C 121 E SWALLOW RD #115 FT COLLINS, CO 80525 77643 1.970-484-3200........ .-......... .......... ................................ .............. Named Insured: ...... ........ ....... ............ ........ .... .................................... .............. LITTLE BOYS TRUCKING, LLC 2302 STANL EY CT FT COLLINS, CO 80526 e-mail address: OLDMANDBW@YAHOO.COM Phone Number: 1-970-631-5449 .......................................................................................................................................................................... Financial responsibility vendor: EXPERIAN 1-888-397-3742 ............................................................................................................................................................................ Policy period: Mar 25, 2009 - Mar 25, 2010 .................*anc...........................M'a"r Ef(eNve date and time: ............................................................................................................................................................................. ................................................... ....... .......................................................... Mar 25, 2009 at 04:45 p.nl. Total policy premium: $3,637.00 ........................................................................................................................................................................... Initial payment required: $380.61 ............................................................................................................................................................................ Initial payment received: $380.61 ........................................................................................................................................................................... Payment plan: 11 payments Rated drivers Failure to accurately and Completely report all driver information may result in premium differences and service delays Date Drivels Original Of Marital license Additional Year Name Birth Age . Status Number Rate Pointy !nformalian CDL CDL issued DAN VVILLIAtdS O4/10j1951 5a Martied "*"8i58 :0 0 Yes 1992 CINDY LOPE' 01/02/1957 52 Marled "'"*'3075 CO 0 Yes 1997 Outline of coverage Policy level coverage Limits Deductible Pemi,m ....................................................................................... Uninsured/Underinsured Motorist $100.... combined single limit $90 ............................................................................................................................................................................ Total policy level coverage $90 Summary level coverage Lim is Dedudble eemiuu, ............................................................................................................................................................................ Liability To Ctthers $2,608 Bodily Injury and Property Damage Liability $1,000,000 combined single limit ..la. i.................................................................................................................................................................31 Medical Payments $5,000 each person ,., „..,3I .............................................................................................................................................................. Comprehensive 138 See Auto Coverage Schedule Limit of liability less deductible L Con'imiM Policy number: 05351504-0 LITTLE BOYS TRUCKING, LLC Page 2 of 12 Collision : 715 See Auto Coverage Schedule Limit of liability less deductible ..... I .... - - ...... ................................. .................. ...... I. ...... ...... ......... ............... ........................ I 1. ...... ............... I Total summary of coverage $3,492 Subtotal policy premium $3,582 'In"s,-'—''... ..... ... ..................***"*"'*....... ......*........'...... Fee '..—*......*................ .............**..........' 20 �,WflIR'eu-d........ .... **"*...... ............*. .........*—""*"''ing 35 .........I..I.............. .......I....... --I.......... ..................................................................... Total 12 month policy premium ............................. $3,637 Rated commodities ................................ -.1.1-1 .......... ............ ......................................................................... - ................... 1. Asphalt (wft 10 tRd Polity number: 05351504-0 LITTLE BOYS TRUCKING, LLC Page 3 of 12 Auto coverage schedule 1, 1991 KW T60 Stated Amount: $28,000 VIN: 1XKADn9X7M5559220 Garaging Zip Code: 80526 Territory: 2 Radius: 100 Personal use: N Body type: 72 Use class: H Liability uabllaY uwulm61 rrledPay .................................................................................................................................................................. Premium 42608 $90 $31 Comp tamp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total Premium $1,000 $138 $7,000 $775 $3,562 Vehicle questions .............................................................................................................................................................................. NONE Financial responsibility information Name ............................................................................................................................................................................. Home address Age Date of blith DAN WILLIAMS Z302 STANLEY Cf 57 04/70/1957 ............................................................................................................................................................................. PT COLLINS, CO 80526-0000 Is DAN WILLIAMS involved in the daily operation of the business? Yes Business information Business type ............................................................................................................................................................................. Sub business Type Other Din, Sand &Gravel Applicant ..........................:............................ Employer ID number Comomtlon or LLC ... .............. ........................ ............................................... ...... .... ......... ......... .. 841611996 1. Does the insured own the property / goods being hauled? No Additional policy questions 1. Year the current business was established: 1992 Failure to provide proof of the year the CLlrrent business was established may result in change in premium. 2. Does the insured currently have General Liability Insurance or a Business Owners Policy? General Liability Insurance Premium discounts Policy ............................................................................................................................................................................. 05351504-0 Business Experience Driver ................................................................................................................................................................... I ......... DAN WILLIAMS CDL Experience Additional Insured information ............................................................................................................ ........... ........ ............... ................... :Additional Insured: CITY Of FT COUINS. PD 90X 580'PT COLLINS, CO 80522 Prior insurance questions ..............:.................................................................................................................................I ............................ Currently insured: No N ConGawul