HomeMy WebLinkAbout495725 STEVE SCHMIDT TRUCKING INC - INSURANCE CERTIFICATE12/29/2011 11:09 3034520237 MACHANN INS AGENCY PAGE 01/02
ACORD CERTIFICATE OF LIABILITY INSURANCE REVISED DATE(MWDDNY)
1 u29/2011
PRODUCER Sef al * 114111
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MACHANN INSURANCE AGENCY
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
SB
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
,ST2
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
NORT GLO. NN,C
NORTHGLENN, CO 80234
INSURERS AFFORDING COVERAGE
NAICS
INSURED
INSURER A; ACUITY
STEVE SCHMIDT TRUCKING, INC.
INSURER B: PINNACOL
P.O. BOX 740
INSURER C:
WINDSOR, CO 80650-0704
INSURER DI
INSURER E'
COVERAGES - -
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN
Abbt
TYPE OF INSURANCE
POLICY NUMBER P
pUCYMFIFNppTIYE
P YEJIFlRAnON
LIMITS
GENERAL
LIABILITY
EACH OCCURRENCE
E 1,000,000
X
COMMERCIAL GENERAL LIABILITY
DAN_AGE Ore«ED'
E 100DOO
A
Q OCCUR
MR) EX- (Ary one arson
E S DOO
T,C:l:Alk:1:6::M,Aoe
PERSONAL6AOVINJURY
Y 110D0,000
L68262
8129/11
6129112
GF-NERAL AGGREGATE
S 2.000 DDD
GENLAGGREGATE LINIOAPPLIESPER:
PRODUCTS-COMP/OP AGO
E 2,000,000
POLICY PRO ! OL
AUTOMOBILE
WISIUTT
ANYAUTO
Fa3B en51.VGLELIMIT
S 1.000,000
ALL OWNED AUTO5
X
A
BODILY INJURY
E
X
SCHEDULEDAUTOS
L68262
8/29111
8/29/l2
TWDamon)
X
HIRED AUTOS
BODILY INJURY
Y
NON -OWNED AUTOS
(PeYx Pnt)
((Fei PERK. DWAOE
E
GARAGE
UARIUTY
AUTO ONLY- EA ACCIDENT
E
EA ACC
OUTO
ANYAUTO
J
7
ONLY.
AUTO ONLY; qGG
EXOEBSNMSRELLA LIABILITY
EACH OCCURRENCE
E
ApGP.EOgiE
Y
OCCURCLAIMS MADE
S
DEDUCTIBLE
RETENTION E
E
E
WORKER'S AND
X W 4 -
lIM
B
EMPLOVERB' LIABILITY
LIABILITY
P..CUTNE
ANYPR0PEl
4061302
111112
111113
EL EACH ACCIDENT
9 500,000
aEaLXCLUDRlR
IfyaS, E tdC w,tlar
EL DISEASE EA EMPL'JYE'e
E SO0.000
SPECIAL PRONSIONS CpIpv
EL DISEASE - POLICY LINK
3 SOO,000
OTHER LIMIT: $100.000
A MOTOR TRUCK CARGO L68262 0129/11 829/12 DEDUCTIBLE: $500
TRAILER INTERCHANGE ..................................... ...... I —...I....... ..................... LIMIT: $80,000 DEDUCT.: $1,000
OESCRTPTION OF OPERATIONSILOCAnONIUVEHICLESfEXCLUVONS ADDED BY ENDOREEMENMJsPECU,L PROVISNINE
CERTIFICATE HOLDER IS AN ADDITIONAL INSURED$ PER ATTACHED CO 2010 (7.04) ON THE GENERAL
LIABILITY, ADDITIONAL INSURED STATUS INCLUDES AUTOMOBILE LIABILITY.
CERTIFICATE HOLDER CANCELLATION
SHOU!D ANY OF THEABOVG OESCRIBED POLICIES BE CANCE1,I,9-0 BEFORE THE EXPIRATION
CITY OF FORT COLLINS
OATS THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS'NPITTEN
PURCHASING DEPT.
NOTICE TO THE CERTIFICATE HOLCER NAMP,O b THE LEFT, BUT FAILURE TO DO SO SHALL
P.O. BOX 580
IMPOSE NO DELIGATiON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
FT. COLLINS, CO $0522-0580
REPRESENTATIVES.
AUTHORRED REPRESENTA nVa
FAX: 970.221.6707
u.VttV ih ILYUT/LIB)
®ACORD CORPORATION 1998
12/29/2011 11:09 3034520237 MACHANN INS AGENCY
ADDITIONAL INSURED • OWNERS, LESSEES OR CONTRACTORS -
SCHEDULED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under
the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. Section II - Who Is An Insured is amended to
include as an additional insured the person(s)
or organization(s) shown in the Schedule, but
only with respect to liability for bodily Injury,
property damage or personal and advertising
injury caused. in whole or in part, by:
a. Your acts or omissions; or
b. The acts or omissions of those acting on
your behalf;
in the performance of your ongoing operations
for the additional insured(s) at the location(s)
designated below.
2. With respect to the insurance afforded to these
additional insureds, the following additional ex-
clusions apply:
SCHEDULE
PAGE 02/02
00-2010F(7.04)
This insurance does not apply to bodily injury
or property damage occurring after.
a. All work, including materials, parts or equip-
ment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by
or on behalf of the additional insured(s) at
the location of the covered operations has
been completed; or
b. That portion of your work out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontrac-
tor engaged in performing operations for a
principal as a part of the same project.
Name of Additional Insured
Person(s) or Organization(s)
(Name and Addimss)
CITY OF FORT COLLINS
PURCHASHING DEFT,
P.O. BOX 580
FF. cai�(s) of Cowered Operatio5ns
ALL PROJECTS