HomeMy WebLinkAbout364578 MISTLER TRUCKING INC - INSURANCE CERTIFICATE (9)�® CERTIFICATE OF LIABILITY INSURANCE OPID 02 DATE(MM/DD/YYYY)
MISTLTR 05 20 09
Truckers' Equity Agency, Inc.
Mary L. Belleville
PO Box 417
Wheat Ridge CO 80034-0417
Phone:303-430-5725 Fax:303-430-7698
INSURED
Mistler Trucking, Inc
Edward Mistler
50419 CR 21
Nunn CO 80648
COVERAGES
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 BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Wilshire Insurance Company
INSURER B:
INSURER C:
INSURER D:
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/DDfYYYY
POLICY EXPIRATION
DATE MM/DD/YYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
PREMISES (Ea occurence)
$100,000
A
X COMMERCIAL GENERAL LIABILITY
BA2496043
05/12/09
05/12/10
CLAIMS MADE `- i OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL SADVINJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 1,000,000
POLICY PROJECT F LOC
AUTOMOBILE
LIABILITY
ANY AUTO
-
COMBINED SINGLE LIMIT
(Ea accident)
$ 1
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 CLAIMSMADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
-
TORY LIMITS ER
E.L. EACH ACCIDENT
$
-'
-ANY PROPRIETOR/PARTNER/EXECUTIVEM
_
OFFICER/MEMBER EXCLUDED?
—
E.L. DISEASE - EA EMPLOYEE
—
$
(Mandatory in NH)
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate Holder is Additional Insured.
CERTIFICATE HOLDER CANCELLATION
CITY OF FORT COLLINS
Fin Svc - Purch Div
FAX 970-221-6707
215 N MASON ST 2ND FLOOR
FORT COLLINS CO 80524
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION',
CITYFOR 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 (2009/011
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