HomeMy WebLinkAbout124167 STEELY TRUCKING INC - INSURANCE CERTIFICATE (8)CERTIFICATE OF LIABILITY INSURANCE OP ID JD DA0 MM/DDYYYY)
�W 09 23 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 policy(ies) 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 endorsement(s).
PRODUCER
NAME:
PHONE FAX
AM No, Eat): INC, No):
_-MAII—
Brown & Brown Inc
4532 Boardwalk Dr, Suite 200
Fort Collins CO 80525
_ADDRESS:
PRODUCER
CUSTOMER ID a: STEEL-1
Phone:970-482-7747 gFax:970-484-4165
INSURED k ytk 1 I
INSURER(S) AFFORDING COVERAGE
INSURER A: secure Insurance A Mutual Co.
I N
22543
Steely Trucking Inc
P O Box 633
INSURER B: Pinnacol Assurance Company
41190
INSURER C:
Wellington CO 80549
INSURER D
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.
ILTR
TYPE OF INSURANCE
NSR
UBR
SWVDI
POLICY NUMBER
MMIDDIYYYY)
MpMp/[ICO(yY�Y�YpY
O
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE W OCCUR
X
CP3183967
09/27/11
09/27/12
EACH OCCURRENCE
$1,000,000
PREMISES(Eaoccurrence)
8100, 000
MED EXP(Any one person)
$10,000
PERSONAL B ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PO -
POLICY n JLC n LOC
PRODUCTS - COMPIOP AGG
$2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON-0WNED AUTOS
A3183968
09/27/11
09/27/12
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
X
X
$
$
A
X
UMBRELLA LIAB X ( OCCUR
EXCESS LIAB CLAIMS -MADE
CU183969
09/27/11
09/27/12
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
DEDUCTIBLE
RETENTION $ 10,000
$
X
S
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNERIEXECUTIVI
OFFICERIMEMBER EXCLUDED?
(Mandatory In NM)
Dyes, tlescribe under
DESCRIPTION OF OPERATIONS below
IA
475882
01/01/11
01/01/12
X - -
TORV LIMIT$ ER
E.L. EACH ACCIDENT
$100,000
E.L. DISEASE - EA EMPLOYEE
$ l0 0 , 0 0 0
E, L. DISEASE -POLICY LIMIT
$500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES LARach ACORD 101, Additional Remarks Schedule, if more apace is quired)
City of Fort Collins included as additional insured regardingrecommercial
general liability as required by contract or permit.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYF1 O I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
215 N. Mason St.
Fort Collins CO 80521
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD