HomeMy WebLinkAbout364578 MISTLER TRUCKING INC - INSURANCE CERTIFICATE (11)From: Sheryl At: Truckers Equity FaxID: 303-430-7698 To: Jenny
Date: 7/232009 08:52 AM Page: 1 of 1
,jE!??T tip CERTIFICATE OF LIABILITY INSURANCE PID SS
DATE (MMfDD1YYYY)
R
07/23/09
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
INSURER D:
Nunn CO 80648
1
INSURER E:
COVERAGES
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
INSR
TYPE OF INSURANCE
POLICY NUMBER
DATE (MM1DD/YYYY)
DATE (MM/DD/YYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
A
X COMMERCIAL GENERAL LIABILITY
BA2496043
05/12/09
05/12/10
PREMISES(Eaoccurence)
$ 100,000
CLAIMS MADE X� OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OPAGG
$ 1,000,000
POLICY jEa LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$1,000 000
A
X
ALL OWNED AUTOS
SCHEDULED AUTOS
BA2496043
05/12/09
05/12/10
BODILY INJURY
(Per person)
$
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 CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
b -
TORY LIMITS ER
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I 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 AUTHORIZED REPRESENTATIVE
ACORD 25 (2009101)
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