HomeMy WebLinkAbout206064 ARNOLD BURNS DBA A & B TRUCKING - INSURANCE CERTIFICATE (5)I ® DATE (MM/00/YYYY)
CORD CERTIFICATE OF LIABILITY INSURANCE OF ID GN 06 03 11
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 CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the po Icy(les) must be endorsed. 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 endomement(s).
PRODUCER
NAME:
-PHONE 'AX
IA/C,MA No Est): (AIC, No):
E
HUB Transportation (CO)
6075 E. 60th Avenue
Commerce City CO 80022
_ADDRESS:
PRODUCER
CUSTOMERID#: ABTRUCI
INSURERS) AFFORDING COVERAGE
NAIC#
Phone:800- 80-0975 Fax:303-287-2311
INSURED O
INSURERA: Wilshire Insurance Company
INSURER B:
A & B Trucking
Arnold & Beverly Burns dba
420 East 57th #55
INSURER C:
INSURER O:
Loveland CO 80538
INSURER E
INSURER F :
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 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.ADUL
INS"LTR
TYPE OF INSURANCE
INSR
SWVD
POLICY NUMBER
(MMIUB O DIDY/VVYY�)IMMIDDIWYY)
TP
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑ OCCUR
EACH OCCURRENCE
$
PREMISES (Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL S ADV INJURY
$
GENERAL AGGREGATE
$
GEHL AGGREGATE LIMIT APPLIES PER
POLICY PRO LOC
PRODUCTS - COMP/OP AGG
$
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEDAUTOS
HIRED AUTOS
NON -OWNED AUTOS
X
BA2480056
07/08/11
07/08/12
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
S
DEDUCTIBLE
RETENTION $
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOWPARTNEWEXECUTIVED
OFFICERIMEMBER E%CLUDED7
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS be.
/A
TORY LIMITS ER '
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E,L.DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remark; Schedule, if more space Is re4�ired)
The ADDITIONAL INSURED endorsement with respects to Auto Liability coverage
is on file with the insurance company.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYFO2 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
PO Box 580
Fort Collins CO 80524
reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD