HomeMy WebLinkAbout364578 MISTLER TRUCKING INC - INSURANCE CERTIFICATE (8)co O® CERTIFICATE OF
LIABILITY INSURANCE OPID 02 DATE(MM/DD/YYYY)
MISTLTR
05 20 09
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Truckers' Equity Agency, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Mary L. Belleville
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 417
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Wheat Ridge CO 80034-0417
Phone:303-430-5725 Fax:303-430-7698
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
INSURER A: Wilshire Insurance Company
INSURER B:
Mistler Trucking, Inc
Edward Mistler
INSURERC:
50419 CR 21
INSURERD:
Nunn CO 80648
i
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YYYY
POLICY EXPIRATION
DATE MM/DD/YYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
PREMISES(Eaoccurence)
$100,000
A
X COMMERCIAL GENERAL LIABILITY
BA2496043
05/12/09
05/12/10
CLAIMS MADE 7 OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL BADVINJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 1, 000 r 0 0,0''
POLICY JEPRO LOC
CT
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per person)
$
A
ALL OWNED AUTOS
SCHEDULED AUTOS
BA2496043
05/12/09
05/12/10
X
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
$
AUTO ONLY: AGG
EXCESS / UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR F,_] CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
-
TORY LIMITS ER
E.L. EACH ACCIDENT
$
-
ANY PROP RI ETOR/PARTNER/EXECUTIVE{----I
-- -
OFFICER/MEMBER EXCLUDED? U
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory in NH)
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER iS ADDITIONAL INSURED
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
FORTCOL 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
CITY OF FORT COLLINS IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
FAX 970-221-6767
PO BOX 580 REPRESENTATIVES.
FORT COLLINS CO 80522 AUT O IZEDRNPRESEN E
AGUKU Zb (ZUU9/U1) U 1988-2009 ACORD CORPORATION. All rights reserved.
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