HomeMy WebLinkAbout127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE (12)03/02/2011 11:44 9704930226 PAGE 02/02
A�oRo® CERTIFICATE OF LIABILITY INSURANCE
°03/001i20011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to tho
terms and Conditions of the policy, certain policies may require an endorsemenL A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsament(s).
PRODUCER Gary Cramer
1275 E Magnolia
Ft Collins, CO 80525
Kri Mamh
PHONE
I Ear: 97 a AIc Ne:97o 4s3-0226
ADDRESS: kri .marsh.004 statefann.rom
INSURER(S)AFFORDING COVERAGE
NAIC 7
INSURER A'
INSURED MICHAEL, DWIGHT DBA MICHAEL
INSURER B:
TRUCKING
INSURER C:
2450 W ELIZABETH ST
INSURER D:
FORT COLLINS CO 80521-4120
INSURER E:
INSURER F :
r.cn rCOTICII`ATL MIUUU2=0• NCVISIUIY IYIJMtltK:
v THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Tq
TYFE OF INSURANCE
POLICY NUMBER
MMJ= UCY SEE
rxP
MN Y
UNITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F—I OCCUR
❑
I
EACH OCCURRENCE
S
PREMISES Ea ucam ,
i
MED EXP(Anyone parson)
i
PERSONAL& AOV INJURY
i
GENERALAGCREGATE
1
GEWL AGGREGATE LIMR APPLIES PER:
POLICY PRO" ,CC
PRODUCTS. COMPIOP AGG
S
=
AUTOMOBILE W&UTYIF
ANY AUTO
ALL OWNED SCHEDULED
X AUTOS AUTOS
NON-Qy eD
HIRED AUTOS PAUTOS
I
355 9543-.A26-OBZ-001
056 2176-DOB-060-001
1I
GOM9D 1N S G
Ca accdort
i
BODILY INJURY (Per pm
-n)
BODILY INJURY (Per acddedJ
g 500000
3 500.OD0
PROPERm
Per aea[}tnt
i
S
UMBRELLA UAB
I EXCESS UAB
HOCCUR
CLAIMS -MADE
I❑
EACH OCCURRENCE
i
AGGREGATE
E
Oro RETENTIONS
9
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROMETORoPARTNER/EXECURVE ❑
OFFICEMEMUER EXCLUDED?
(Mandemry In NH)
9 yoc doccr%n unaar
N I A
WC "rjTU-
5
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYER
S
E.L OI5EASE-POLICY LIMB
a
OESCRIPDON OF OPERATIONS (LOCATIONBI VEHICLES Is reouiredl
97 PETERBUILT 379L 87 PETERBILT
DUMP DUMP VIN:1XP50B9X9VD411546
VIN: U374171GL
rwwrrcr r wYlnm
City of Fort Collins Purchasing
SHOULD ANY OF THE ABOVE DESCRIBED POLICI BE CANCELLED BEFORE
THE EXPIRATION DATE'THEREOF, NC IC WILL BE DELIVERED IN
215 N Mason
ACCORDANCE WITH TFjE POLICY PROVISION
2nd Floor
AUTHORIZED REPRES THE
Fort Collins CO 80524
I(Po,1glr-2010 ACURU GUKFfJKA I lUN, AD ngma reservea.
ACORD 25 (2010105) The ACORD name and logo are registered T ark4 of ACORD 1001486 132849.6 11-15-2010
03/02/2011 11:44 9704930226
PAGE 01/02
� Gary Cramer State Farm Insurance
1275 E. Magnolia #T, Fort Collins CO 80524
IM}Y\A1�1 Ph (970) 484-1374 Fx (970) 493-0226
gary.cramer.b68o@statefarm.com
To: Cito of Ft Collins -Purchasing From: Kristy Marsh
Fax Number, 970.221-6707
Number of pages including cover: 2
Notes:
Date: 03.01-2011
Re: Dwight Michael