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Home My WebLink About127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE (13)07/15/2011 08:53:38 AM PINNACOL ASSURANCE PAGE 2 OF 3 ACORD'" CERTIFICATE OF LIABILITY INSURANCE °ATE 07115Con 11 oTnsrz PRODUCERPINNAASSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 501 Lowry Blvd 7501E o Denver, CO 80230-7006 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC4 INSURED DWIGHT J MICHAEL DBA MICHAEL TRUCKING INSUPERA PINNACOL ASSURANCE 41190 - 2450 W. Elizabeth Street Fort Collins, CO 80521 INSURERB rvsuaeP c INSIwER D. NB RERE' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMMENT 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. IrvSR ADm paucv EEEECN•.E PLOLYE-IRATION LTR INSRD TYPE OF INSURANCE POULYNUYdER DATEN.MA6AM91 DATEMMUDHYW UNITS GENERAL LIASHUtt EACH OCCURRENCE DAIRGE TO RENTED TDIMERCALGIE"ERALUASILI CWMSMADE 0 OCCUR ENEWEES WDEav n PERSCNALSADVINARV CE NL AGGREGATE LIMIT APPUEPS PER L£NEPAL AGGREGATE PRODUCTS - COMP/OP AGG POIILY PROJECT LOC AUTO DIRE WOILITY CWBINEDSINGLEOMIT ANYAUTO Ea Ateiaent BODILYINJURY ALL OWNED AUTOS SCHEOUIEDAUTCs Per < BODILYINJURY HIRED AUTOS NOWOWNEO AUTOS Pe'd.enl PROPERTY DAMAGE Fer OldenD GAPADE Lv EIUW AUTOONLY-EA ACCIDENT OTHER THAN EAACC ANYAUTO AUTO ONLY. Ar;cj E%CED"IWIRE W UABIUW EACH OCCURRENCE AGGREGATE OCCUR CWMSMNIE DEDUCTIBLE RETENTION S WORKERS COWENSAMONAND WC STAILL 11 OTHER A EWLOYER9 LIABILITY ANY PFOPRIEIDRPAPLNERff xELUTIVE 1169069 07/1312011 07/01/2012 TS rACH L EACH E.ACCIDENT ACC $100,000 OFFlCEFMEMBEP EXCLUDED? E.LDISEPSE-EA EMPLOYEE j100.000 If yes. please describe under SPECIALPRMIS ON5 Stud v ELOISEASE-pOLICYUMIi SOO OW OTME0. DESCRIPTIONOF OPERATIONSILOCAnONS HICLESIE%CLUSIONS ADDED BYENDORSEMENT'SPECIALPROASIONS CERTIFICATE HOLDER CANCELLATION 1323949 SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE JOHN STEVENS THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR T 215 NORTH MASON ST. MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE FORT COLLINS CO 80524 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Courtney Prusse ACORD 25)2001108) New Business Representative ACORD CORPORATION 1988 07/15/2011 08:53:38 AM PINNACOL ASSURANCE PAGE 3 OF 3 CERTIFICATE HOLDER COPY JOHN STEVENS 215 NORTH MASON ST. FORT COLLINS CO 80524 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. 07/15/2011 08:53:38 AM PINNACOL ASSURANCE PAGE 1 OF 3 ASSURANCE Date 07/15/2011 To: JOHN STEVENS Fax Number: 970-221-6707 From: Teresa 303-361-4020 Phone Number: 303-361-4020 Subject: Document: UW135 34309764 Policy #: 4149369 Total Pages: 3 Notes: Please contact us if you did not receive any portion of this transmission. 7501 E. Lowry Blvd. Denver, CO 80230-7006 Phone:303-361-4000 www.pinnacol.com The information contained in this lelecopy transmission is confidential or privileged and is intended to be for the use of the individual or entity named on this transmission sheet. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this telecopied information is prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the retrieval of the original transmission.