HomeMy WebLinkAboutJW TRUCKING - INSURANCE CERTIFICATE (4)04/02/2009 08:52 9703770668 CINDY GERK PAGE 01/01
CERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company If aelection box is not ch 9ckad.
6000 Amoricaln Pky Madfaon, IWluonoin 337 a3-0001
Insured's Name and Address Agent's Name, Address ar d Phone Number (Agt/Nst.)
J & W Trucking Cindy Gork (070) 377- 70
2007 HoCkport Court 4050 Timberline Rd. St . 100
Fort Collins, CO 80528 Fort Collins, CO 80525 27 (016/316)
This cartlttcata is issued se a matter of information only and confers no rights upon the Certificate of
r.
Thia certificate does not amend, extend Or alter the coverage afforded by the policies listed below.
Thfe Is to cerdty that polkiea of Insurance Wad below have been Lsaletl to Ine Insurod named above for me policy period Indkated, tII g any requiran?enf, ?arm or caa5um
on of or other
dawment wim respeet to which mia earNflrate may bo blued or may perialn, the bteurance afforded by the polfcles de6eribed herein Is x d two a!p me leans, exduvlona, and Bondi ice& of awh "Toles.
POLICY DAT,
TYPE OF INSURANCE POLICY NUMBER Mo D Tr Mc EXPIRATION t. 11IM OF LIABILITY
Homeowners/ liadlfy Iryury nd Property Damage
Mobitahomaownere Liability tarn u= cc $ 000
Boatowners Liability Bec ty Inlwy dnd Properly Damage
Each occum IIl a $ loco
Personal Umbrella Liability epday imm end Property Damage
Each Occu e $ ,000
FalT1/Rench Liability
Farm 4ebflhy & Pereaml abohy
troorkera Compenoation a,W
Employers Liability t
General Liability
Z Commercial General
L-WAIlly (vuwrrence)
co
Businessowners Liability
Liquor Liability
Autornobtio Liability
A Any Auto
I] All fawned Autos
05-XN4699-01-00 1 3/12/2009 1 3/12/2010
❑ Schndulml Awns 05 xN�st36 0,�, 00
❑ Hired Auto
C Nonownad Autos
Q
Excess Liability
L7 Commercial Blanket Excess
Other (Miscellaneous Coverages)
Comp and Gollision deductible $1,000
o "GRIP9nN nF nPFPA . LrICA'nOIJC / VZHi LE / REBTrgio noNE / a
The Certificate Holder is listed as Additional Insured
. City of Fart Collins
215 N Mason Street 2nd Floor
PO BOX 580
Fort Collins, CO 8052-2
fax: 970 221 6707
Eachoccurro
ee
5
.000
Farm Employ
Each occurre
9n,lulmy
1p Uabinty
ce
$
000
#-k�s4llkeelreir
Each Aedden
$
p00
DLseem-
Ernpfoyea
$
1000
Dmaaae - Poi
ca,eral Aagr
unit
ate
$
S
loco
4.000 nnn
Medical Eyperise
(Any One Person $ 5,0oo
Each occurre
cat fi $ 1000
AWnWte?T
$ loco
common C
Lirrtl $ 000
Aggregate
$ 1000
Bomly lrtpay.
Inch Person $ 1,000 ,000
ftdlyfro"- IZaahA00ent
$ 1,000,000
3/12/2010
3/12/2011
P�epertyDo
e $ 1,000 ,000
50o0y Iniury a
Property Damage combinad $ 000
Each OtzurMn
WAggragate $ 1000
L rTCM3
1 tndhliduel a pu6rms chmer a Inqura4 Ftevn ❑How apt
I
elected to ba loosed a employees under doe pdcy,
ttPn&,da4empleted opereMm agpVto m oppI le Bad,
oceunenee emit and Is hPludad In pour egprepata
Lau Should any of the abovd described policies be cancelled W65
expiration date thereof, the t ompany will endeavor to mail'( 20 c
m,640n notio? to the Cortifidete 1-lafder named, but failure to mail
notice shall impose no ofSligation or liability of any kind upon
company, I� aS)ents or rbpresentadves. 'TO days unless difh
number of days own.
0 This certillies coverage on the date of issue only. Tha
described policies are sub ect to cancellation In conformity with
terms and by the laws of thii state of issue.
4/2/2010
U-201 Ed. SMO I Stock No. Ot3W Rely. 7/n7.