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HomeMy WebLinkAbout112297 VINEY TRUCKING INC - INSURANCE CERTIFICATE (4)"� OP ID JL ACORD . CERTIFICATE OF LIABILITY INSURANCE' VINEY-1 1 DATE (MM/DD/YYW) _ 05 11 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance Agcy-Johnstown HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4848 Thompson Pkwy, Ste 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Johnstown CO 80534 Phone: 970-635-9400 Fax: 970-635-9401 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Pinnacol Assurance- 41190 INSURER B: ' - Viney Trucking, Inc. Dba Duane Vine Trucking 2507 Brook 111 Rd. Ft. Collins CO 80524 INSURER C: INSURERD: INSURER E: nnVFRAnFR -- - 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES (Ea occurence) $ COMMERCIAL GENERAL LIABILITY N/A CLAIMS MADEEl OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PROECT LOC J AUTOMOBILE LIABILITY ANY AUTO N/A COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per. accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT.. .$ . OTHER THAN' EA ACC $ ANY AUTO N/A $ AUTO ONLY: .AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MADE N/A AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND -' -" "-"""` X I TORY LIMITS IT I ER A EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 1963162 06/01/09 06/01/10 E.L. EACH ACCIDENT $ 100,000 _E.L DISEASE -EA.EMPLOYEE _ _$-_.10Q,Q�o____ _ OFFiCEFLir4EY1rER EXCLUCED? --= - Bix' WXANX9 0*' SU.RoGWzX.0 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 500 , 000 OTHER N/A DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS Attn: Jan - Purchasing Dept P O Box 580 FORT COLLINS CO 80521 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 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001108) © ACORD CORPORATION 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 (2001/08)