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HomeMy WebLinkAbout127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE (14)07/10/2011 10:20 9704930226 PAGE 01/03 • » -•- Gary Cramer State Farm Insurance 1275 E. Magnolia #I, Fort Collins CO 80524 Mt Ph (970) 484 1374 Fs (9-10) 493-0226 gary. cramer.Wo@statefarm, care kristy.marsh-r104@statefann.com TO:, City of Eort Collins -Purchases From: Kristy Marsh Fax: 970-221-6707 Date: 07/18/11 of Pages: RED ly�g_it Ml ael- Track1l)g Notes: Give me a call if yp�1 have any questions T n s so mucks 1Crist 07/18/2011 10:20 9704930226 --om"N PAGE 02/03 ^�� CERTIFICATE OF LIABILITY INSURANCE °o7ns20°11i"' 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 pollcy(les) must be endorsed. It SUUROGATION IS WAIVED, subject to the tents and conditions of the policy, certain policies may require an endorsement A statement on this certificate doss not confer rights to the certificate holder In lieu of such endomement(s). pRO01ICER Gary Cramer State Farm 1275 E Magnolia Unit I Fort Collins, CO 80524 NONE Nnsly Marsh PNONE 1374 "i 9 26 E�fiss: kris .marsh.r104 atefalm.Com AFFORDING COVERAGE NAID3 QINSURERS BURERA: INSURED MICHAEL, DWIGHTJ INSURERS: INSURERC: DBA MICHAEL TRUCKING rsuRERD: I 2450 W ELIZABETH ST FORTCOLLINSCO 80521.4120 SURERF: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTAITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO VMICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 3UaJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. LrTRR TYPE OF INSURANCE Pd.ICY N tl EFF (MNMR= LIMITS CENBYAL LIABILITY EACH OCCURRENCE E COM ERCW. GENERAL LIABILITY OLANSMAOE ❑OCWft pRE I 3 MED E%P (Airy One pcxm) f PERSONAL&AOVINJURY S GENERAL AGGREGATE 3 GEM AGGREGATE POLICY LIlwllr DUES PER; PRO- LOC PRODUCTS-COMpop AGG S S AUT(WO91LE UAWUT' WRIT Ea -dd- $ x ANY AUTO AllOOISMIED UOEDI$ED NUTLOI.wEo HIRFAAUTOS AUTOS S559543-A26-0BZ-M 05521764)08-060-001 e71211=11 040a12011 01/2612012 Ididarmll BOD&Y'NIURY(PCP f i &OrJ,rxlD BODILY INJURY(Pyr pq3) i WO•O avcdnq i 500,000 S UMerEDA EIAB OCCUR EACH OCCURRENCE S AGGREGATE 9 EXCESS LIAR CIAMS.LaDE DED RETEMION3 3 ANDEYPILrYEASLNLe0.1TY AM pROpfiIRM GXCLUD R�XECUTIYE YIN OFFICE/MEIAaER DlCLUOEm ❑ MN!!!! NIA t oTN- L S E.L. EACH ACCIDEM 3 MP E.L OISEASE-EA ELOYE 3 rm.d In NH) If yes. d..Q" x4w E.L DISEASE-MLCY LWn i MSCRP ION OF OeSRAnOea I LOCATNHl3 f VERICLES WA - ACORO 101, Ado N0 ftm a hN *, R AIOM1 apwa b rtRubml 97 PETERBUILT 379L 97 PETERBILT DUMP DUMP VIN: IXP5D09X9VD411546 VIN: D374171 GL City of Fort Collins Purchasing 215 N Mason 2nd Floor Fort Collins, CO 80524 SHOULD THE ABO ES POLICI E CANCELLED 13EFORE N DATE ERFjF,�N4TICE LL BE DELIVERED IN 1 L11Te A{rAAIU WNYOItA I ION. All fights mea"Od. ACORD 2S (20'10105) The ACORD name and logo are registered of AGORD 1001486 132849.6 11-15-2010 07/16/2011 10:20 9704930226 PAGE 03/03 CERTIFICATE OF LIABILITY INSURANCE °07118120111 THIS CERTIFICATE 13 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: H the certificate holder is an ADDITIONAL INSURED, the poliey(les) must be endorsed. N SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require Bn endorsement. A Statement On this certificate, does not confer tights to the certificate holder In lieu of such enOoraement(5)- °RO° Gary Cramer State Farm 1275 E Magnolia Unit I Fort Collins, CO 80524 �AMNTIG `T Kristy March PHONE s 970 484-1374 C NI' 97 93-0226 A E : kns .marsh.r104 tefann.com UISIIR 9 AFFORDING COYFIUGE NAIG4 INSURER A: INamw MICHAEL, DWIGHT J DBA MICHAEL TRUCKING 2450 W ELIZABETH ST FORTCOLLINSCO 80521-4120 INSURERS: INSURERC: INSURER D: f PISURER 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 6MTH 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. � TYPEOFWSURANCE POLICY NUMBER YYID YfJtD LIMAS 006RAL LW9IUTY COMMERCIALGENERALLIABLITY CLAIMS E OOCCUR FACM OCWRRENCE E PREMISES Ee OwmVixo $ MEO LxP(AOy one pb5p,) E PER80NAL E. ADV EJURr E GENERALgGGRECr17E 4 GENL AGGREGATE TART APPLIES PER Poucy LOG IPRODUCTS-COWWAGG $ E BILE LIABILITY AUTO �OS NED�OSU�9ODWYWJURY(Pe�rcMV) AUTOS AUTOS O S5595&3-A2&46Z-Wl 01126=11 061=2012 M IN ITE EA �BNED BODILY PLURY(Perpereon) E 500,000 RIMIRED 5 500,000 Per E SD0,00o 9 UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S DELI I I RETENTIONS S INORXE" COMPENSATION MID EMPLOYERS UAOLRY ANY PROPRET0PJP R NF ECUnVE TIN OrrtCEMFJMBER EXCLUDED? ❑ (1196a rr In"I B Yrc.d w*-vdc NIA WC STgTIh O1H- RR EL EACH ACCIDENT S E.L. DISEASE -EA EMPLOYEE S E.L. DISEASE -POLICY UNIT S P4ECIePTgN OF OPENAl10N91 LOGTIDNS I VEHICLES IAma, ALORD f01, AdtlManal Rama,b Schedule. Nnrore flHcO O ro0uflO) 97 PETERBUILT 379L DUMP VIN: 1 XP5DB9XSVD411545 City of Fort Collins Purchasing 215 N Mason 2nd Floor Fort Collins, CO 80524 ACORD 2512010106) SHOULD ANY OF THE ABOVE DESCRIBED PO4CIES BE CANCELLED BEFORE THE EXPIRATION 04�11E THEREOF, NOTIM WILL BE DELIVERED IN I F 1958-ZUI0 ACORO CORPORATION. A6 rights reserved. The ACORD name and logo are reglatelledlAarks of ACORD 1001486 132649.6 11-15-201(