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HomeMy WebLinkAbout110453 HOUSKA AUTOMOTIVE SERVICE INC - INSURANCE CERTIFICATEAc'OM& CERTIFICATE OF LIABILITY INSURANCE ��. DATE IMMIDDOYYY) 4/11/2011 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditionsof the policy, certain policies may require an endorsement. , A statement on this certificate does not confer rights to the certificate holder in lieuof such endorsement(s). - - - PRODUCER. _ _ "'"' Zurich, Account Service Center 7D45College Blvd. CONTACT Zurich N.A: -Account Service Center NAME: -_ - AIO No. EXT: 877-225-5276. �. I FAX - A/C No: 888-734-6776. E-MAIL service.center@zurichna:com ADDRESS: Overland Park, KS 66211 Fax:888-734-6776 Ph:877-225-5276 Opt.1 INSURERS AFFORDING COVERAGE NAIC # INSURED 0128587-00 INSURER A: Universal Underwriters Insurance Company 41181 HOUSKA AUTOMOTIVE SERVICES, INC.; DJ & N LEASING SERVICES, LLC; D & N HOUSKA FAMILY,LLC INSURER B: Universal Underwriters of Texas Ins. Co. 40843 INSURER C: 899 RIVERSIDE AVENUE FORT COLLINS, CO 80524 INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DD'LNSRD1WVo POLICY NUMBER POLICY EFF (MMIDDONVY POLICY EXP Y) (MMIDD/YVY LIMITS A GENERAL LIABILITY 0 COMMERICAL GENERAL LIABILITY CLAIMS MADE ® OCCUR ❑❑ ❑ ❑ EACH OCCURENCE $300,000 DAMAGE TO RENTED PREMISES (Ea occurrence $ MED (Anyone $ ❑ — 286827 04/01/2011 04/01/2012 RYon) INJURY AL 8 ADV NJ PERSONAL $ ❑ — GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: ElPOLICY❑ PROJECT ❑ LOC _ __ PRODUCTS - COMPIOP AGG_ $ _ A AUTOMOBILE LIABILITY, - ❑ANY AUTO " ❑ ALL AUTOS D AUTOS ' ® SCHEDULED ® HIRED AUTOS ❑ ❑ - - 286827 04/01/2011 04/01/2012 COMBINED SINGLE LIMIT (Ea Accident). $300,000•, r BODILY INJURY (Par Person) '$ BODILY INJURY (Par accident)$ PROPERTY DAMAGE Peracodenf $ $ ® NON -OWNED AUTOS $ A ® UMBRELLA LIAB ® OCCUR ❑ EXCESS LIAR ❑ CIAIMSMADE ❑ ❑ EACH OCCURRENCE $ 5,000,000 AGGREGATE $ ❑ DEDUCTIBLE ® RETENTION $ 0 286827 04/01/2011 04/01l2012 PRODUCTS-COMP/OP AGG $ 5,000,000 $ WORKERS COMPENSATION AND ❑WC STATU- ❑H OT- EMPLOYERS'LIABiLItt TORRLIMITS _ ER ANYPReaRIELOR? RTNEWEXECVTNE YIN OFFICERIVEMBEREXCLUDED'' ❑NIA❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS bolo, -- E.L. EACH ACCIDENT $ EL.DISEASE -EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT A GARAGE LIABILITY F-1 ANY AUTO El El 04/01/2011 04/01/2012 OTHER THAN AUTO ONLY EACH OCC $300,000 A CUSTOMER AUTO -DIRECT PRIMARY ❑ ❑ 286827 04I01/2011 04/01/2012 $ 450,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 1D1, Additional Remarks Schedule, if more space is required) Reason for Certificate: TOWING AGREEMENT. INCLUDES ON -HOOK COVERAGE. 30 day notice of cancellation applies, except for cancellation due to non-payment of premium. See Additional Remarks Schedule Attached CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF FORT COLLINS ACCORDANCE WITH THE POLICY PROVISIONS. 215 NORTH MASON STREET PO BOX 580 FORT COLLINS, CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION, All rights reserved V ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Ac'OM& CERTIFICATE OF LIABILITY INSURANCE ��. DATE IMMIDDOYYY) 4/11/2011 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditionsof the policy, certain policies may require an endorsement. , A statement on this certificate does not confer rights to the certificate holder in lieuof such endorsement(s). - - - PRODUCER. _ _ "'"' Zurich, Account Service Center 7D45College Blvd. CONTACT Zurich N.A: -Account Service Center NAME: -_ - AIO No. EXT: 877-225-5276. �. I FAX - A/C No: 888-734-6776. E-MAIL service.center@zurichna:com ADDRESS: Overland Park, KS 66211 Fax:888-734-6776 Ph:877-225-5276 Opt.1 INSURERS AFFORDING COVERAGE NAIC # INSURED 0128587-00 INSURER A: Universal Underwriters Insurance Company 41181 HOUSKA AUTOMOTIVE SERVICES, INC.; DJ & N LEASING SERVICES, LLC; D & N HOUSKA FAMILY,LLC INSURER B: Universal Underwriters of Texas Ins. Co. 40843 INSURER C: 899 RIVERSIDE AVENUE FORT COLLINS, CO 80524 INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DD'LNSRD1WVo POLICY NUMBER POLICY EFF (MMIDDONVY POLICY EXP Y) (MMIDD/YVY LIMITS A GENERAL LIABILITY 0 COMMERICAL GENERAL LIABILITY CLAIMS MADE ® OCCUR ❑❑ ❑ ❑ EACH OCCURENCE $300,000 DAMAGE TO RENTED PREMISES (Ea occurrence $ MED (Anyone $ ❑ — 286827 04/01/2011 04/01/2012 RYon) INJURY AL 8 ADV NJ PERSONAL $ ❑ — GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: ElPOLICY❑ PROJECT ❑ LOC _ __ PRODUCTS - COMPIOP AGG_ $ _ A AUTOMOBILE LIABILITY, - ❑ANY AUTO " ❑ ALL AUTOS D AUTOS ' ® SCHEDULED ® HIRED AUTOS ❑ ❑ - - 286827 04/01/2011 04/01/2012 COMBINED SINGLE LIMIT (Ea Accident). $300,000•, r BODILY INJURY (Par Person) '$ BODILY INJURY (Par accident)$ PROPERTY DAMAGE Peracodenf $ $ ® NON -OWNED AUTOS $ A ® UMBRELLA LIAB ® OCCUR ❑ EXCESS LIAR ❑ CIAIMSMADE ❑ ❑ EACH OCCURRENCE $ 5,000,000 AGGREGATE $ ❑ DEDUCTIBLE ® RETENTION $ 0 286827 04/01/2011 04/01l2012 PRODUCTS-COMP/OP AGG $ 5,000,000 $ WORKERS COMPENSATION AND ❑WC STATU- ❑H OT- EMPLOYERS'LIABiLItt TORRLIMITS _ ER ANYPReaRIELOR? RTNEWEXECVTNE YIN OFFICERIVEMBEREXCLUDED'' ❑NIA❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS bolo, -- E.L. EACH ACCIDENT $ EL.DISEASE -EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT A GARAGE LIABILITY F-1 ANY AUTO El El 04/01/2011 04/01/2012 OTHER THAN AUTO ONLY EACH OCC $300,000 A CUSTOMER AUTO -DIRECT PRIMARY ❑ ❑ 286827 04I01/2011 04/01/2012 $ 450,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 1D1, Additional Remarks Schedule, if more space is required) Reason for Certificate: TOWING AGREEMENT. INCLUDES ON -HOOK COVERAGE. 30 day notice of cancellation applies, except for cancellation due to non-payment of premium. See Additional Remarks Schedule Attached CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF FORT COLLINS ACCORDANCE WITH THE POLICY PROVISIONS. 215 NORTH MASON STREET PO BOX 580 FORT COLLINS, CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION, All rights reserved V ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ©1988-2010 ACORD CORPORATION, All rights reserved ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ©1988-2010 ACORD CORPORATION, All rights reserved ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 0128587-00 LOC #: sa�oRO' ADDITIONAL REMARKS SCHEDULE Page- 3-of-3- AGENCY NAMED INSURED Zurich, Account Service Center HOUSKA AUTOMOTIVE SERVICES, INC.; DJ & N LEASING SERVICES, LLC; D & N HOUSKA FAMILY,LLC 899 RIVERSIDE AVENUE POLICY NUMBER 286827 FORT COLLINS, CO 80524 CARRIER NAICCODE UNIVERSAL UNDERWRITERS INSURANCE COMPANY 41181 EFFECTIVE DATE: 0410112011 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, Drsement 089-Umbrella Limit Inclusive applies. Certificate Holder is named as an Additional Insured. applies to the Garage Liability. ACORD 101 (2008101) © 2008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 0128587-00 LOC #: sa�oRO' ADDITIONAL REMARKS SCHEDULE Page- 3-of-3- AGENCY NAMED INSURED Zurich, Account Service Center HOUSKA AUTOMOTIVE SERVICES, INC.; DJ & N LEASING SERVICES, LLC; D & N HOUSKA FAMILY,LLC 899 RIVERSIDE AVENUE POLICY NUMBER 286827 FORT COLLINS, CO 80524 CARRIER NAICCODE UNIVERSAL UNDERWRITERS INSURANCE COMPANY 41181 EFFECTIVE DATE: 0410112011 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, Drsement 089-Umbrella Limit Inclusive applies. Certificate Holder is named as an Additional Insured. applies to the Garage Liability. ACORD 101 (2008101) © 2008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD