HomeMy WebLinkAboutSJW TRUCKING INC - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company if selection box is not checked.
6000 American Pky Madison, Wisconsin 53783-0001
Insured's Name and Address Agent's Name, Address and Phone Number (Agt./Dist.)
SJW TRUCKING INC Christina Wanamaker (970) 674-3223
11083 Highway 14 1200 W. Ash St. Unit F
Ault, CO 80610 Windsor, CO 80550-4610 (025/316)
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 listed below.
.COVERAGES
This is to certify that 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.
TYPE OF INSURANCE
POLICY NUMBER
D
LIMITS OF LIABILITY
-POLICY
EFFECTIVE EXPIRATION
Mo Da Yr Mo Da Yr
Homeowners/
Bodily Injury and Property Damage
Mobilehomeowners Liability
Each Occurrence $ '000
Boatowners Liability
Bodily Injury and Property Damage
- - -
-
-
Each Occurrence $ ,000
Personal Umbrella Liability'
Bodily Injury and Property Damage
Each Occurrence $ 000
Farm/Ranch Liability
Farm Liability 8S Personal Liability
Each Occurrence $ 000
Farm Employer's Liability
Each Occurrence $ 000
Workers Compensation and
Statutory
Each Accident $ '000
Employers Liability t
Disease - Each Employee $ ,000
Disease - Policy Limit., , -. ; $ . 10.0
General Liability
General Aggregate', 000
Pro ducts -completedOp. e"ration`sAggregate $'-.4,000;,'000
® Commercial General
Liability (occurrence) -
❑
❑
- - --`
05XN 3800 01
02/24/2009
02/24/2010.
personal and Advertising Injury'. �. -- $ - 2,000 am
Each Occurrence $ - 2;000 ,000
Damage to Premises Rented to You $ 100 000
Medical Expense (Any One Person) $ 5 000
Businessowners Liability
Each Occurrencet t $ '000
Aggregatett $ '000
Liquor Liability
Common Cause Limit $ 000
Aggregate Limit $ '000
Automobile Liability
❑ Any Auto
® All Owned Autos
BodilyInjury - Each Person
$ 1,000 ,000
Bodily Injury - Each Accident $ 1,000 000
® Scheduled Autos
❑ Hired Auto
05XN 3800 02
02/24/2009
02/24/2010
Property Damage $ 1 000,000
❑ Nonowned Autos
R1
Bodily Injury and Property Damage Combined $ ,000
Excess Liability
❑ Commercial Blanket Excess
Each Occurrence/Aggregate $ 000
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS t The individual or partners shown as insured ❑ Have ❑ Have not
• elected to be covered as employees under this policy.
. t t Products -Completed Operations aggregate is equal to; each
• - occurrence limit and is included in policy aggregate. "
3. CERTIFICATE HOLDEEi?S NAME'ANDfADDRESS -°
CANCELLATION`„ � e' „M'
• ADDITIONAL INSURED
CITY OF FORT COLLINS
Should
Should any of the above. described policies be cancelled -before the
date thereof, the company will endeavor to mail'( r days)
written notice to the Certificate Holder named, but failure to. mail -such -
notice shall impose no obligation or liability of any kind upon•, the
company, its agents .or, representatives. '10 days unless different
number of days shown.
215 N MASON
FORT COLLINS, CO 80521
❑ This certifies coverage on the date of issue only. The above
described policies are subject to cancellation in conformity with their
terms and by the laws of the state of issue.
DATE ISSUED
AUTHO ZED�RESENTAT VE
2/26/2009
U-201 Ed. 5/00 Certificate Holder Stock No. 06668 Rev. 7/02