HomeMy WebLinkAbout127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE (9)04/02/2010 10:07 9704930226 PAGE 01/01
A iCC>RbF CERTIFICATE OF LIABILITY INSURANCE°A�IArMIDDY10
04/02/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, TH15
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR .ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTFICATE HOLDER,
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polio Les
terns and conditions of the policy, certain Y( )must be endorsed. Qn. If SUBROGATION I$ WAIVED, Subject to tho
certif ate holder in lieu of such andorsemmWs) policies may regLnre an arldorsament A >:ta0emerlt on this ( does not confer rights to tFIA
PRODUCER
CRAMER STATE FARM GARYCRAMERor LISA KELLY
PNCNN
LISA KELLY - 970-484-1374 -
w FAX Na ; sip 4s3o22s
IL
j 1275 E MAGNOLIA ST #1 ° CE
L& FORT COLLINS CO 80524 o
INSURED INSURE $AFFORDING COVERAGE NAIC a
INSURER A! State Farm Fire and Casualty Company 2514$
MICHAEL, DWIGHT dba MICHAEL INSURER B ;
TRUCKING INSURER c
2450 W EL17AABETH ST �=UMRER'R6:
FORT COLLINS CO 80521 EE:
INSURER F
OVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POUCIJ 5 OF INSURANCE LISTED BELOW NAVE 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IR TYPE OF tNSURANCe F pLI
POLICY NUMBER LIC LIMITS
XP
GENERAL LLABILITY IDD
EAC►+OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR P�WE0 Eel >B
GEN'L AGGRE
G
A
T
E UMITAP(PLILIEFS PER;
POLICY { j PRO-
JECT f LOC
AUTOMOBILE LLABIUW
ANY AUTO
ALL OWNED AUTOS
X SCHEOULEO AUTOS
HIRED AUTOS
NON -OWNED AUTOS
UM91WUAUAB OCCUR
EXCESS LIAR .,..,..,.
DEDUCTIBLE
WORKERS COMPBNSATioN
AND EMPLOYER& LIABILITY
ANY PROPRIETOR/PARTNERCKECUTIVE YIN
OFFtCCRIMEMeEREXCLUDED7 I I LA
(Mawglary in NN)
NN Yes. d9eC�'fie under
MED EXP (Arty one person)
g
PERSONAL S AOV INJURY
$
GENERAL AGGREGATE
S
PRODUCTS - COMn/0P AGO
=
S
055 2176-DO$-05N-001 10108M009 04i0812010 COMBINED SINGLE LIMIT
{Ea awdenl)
$
500,000
177 0697 F09-06 -001 0112W010 V"ZW-AU'U BODILY INJURY (perpo7m)
$
5p0 000
BODILY INJURY (Per a=xim)
$
500,000
PROPERTY DAMAGE
(Per acaidant)
=
500,000
S
s
EACH OCCURRENCE
S
AGGREGATE
S
8
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AUath ACORD 101, Addloollal Ramadw Scham,tq if IOure spgee is ragWrgd)
CITY OF FORT COLLINS
215 N MASON ST
FORT COLLINS CO 80525
E.L. EACH ACCIDENT Is
El, DISEASE • EA EMPLOYE $
E. L, DISEASE - POLICY LIMIT I S
SHOULD ANY OF THE ABOVE DESCRIBED PCUCIEB BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE VYITH THE
POLICY PROMMONS,
ACORD 25 (2009/0S) The ACORD name and 1 y88- ACORD CORPORATION. All right reserved.
Ego are reg red riI of A ORD 1001486 132849A 02-11-2010