HomeMy WebLinkAboutORE CART TRUCKING - INSURANCE CERTIFICATE�R�® CERTIFICATE OF LIABILITY INSURANCE OPlo' DW ' UATE,MMIDD
03/14/12
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
f'..�.,..;
'HUB.'Transportation (UT).
-
NAME:
HO No ONE Eat: _.
(A/C; No):
_. _
ADDRESS: ::.. .- r..; ..... .. .. .....
P. 0.,,,Box 17346
--Salt -Lake. City;- -UTI 8411-7'-- - --------- -
'Phonle-801-943-2600 Fax:801 943-3889
wsroMERIDa:'- ORECARl--
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURED
"
-
INSURER A: Northlmd insurance Co. (NTDT
-24015
Tereear'Adait
dba:(Ore Cart Truc]-
INSURERS:
INSURERC:
5406 Farrwa' y Siz Drive
Fort Collins CO 80525
INSURERD:
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. NOTWITHST.'W DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER nOCUMENT 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.
LTR
TYPE OF INSURANCE
INSR
WVD1
POLICY NUMBER
(MMIDD/YYYY)
IMM/DD/YYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
PREMISES Ea occurrence
E 100,000
A
X COMMERCIAL GENERAL LIABILITY
WN090560
03/14/12
03/14/13
MED EXP (Any one person)
$5,000
CLAIMS -MADE OCCUR
PERSONAL B ADV INJURY
$1,000,000
GENERAL AGGREGATE -
s2,000,000-
- --�
..,.
GENT AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP/OP AGG
s2-, 000, 000.-.
.. ... __
$'
POLICY. PRO- ,. LOC
"
AUTOMOBILE
LIABILITY
_ -..
-
..- .._
COMBINED SINGLE LIMIT
_... ....E
(Ea accident)
2, 000_:-000
ANY AUTO: n':'C.1..[(
,
BODILY INJURY (Per person)'
$ - -- — _..
BODILY INJURY (Per accident)
$
ALL OWNED AUTOSI
-'- - --
—'- -"- -
A
SCHEDULEDAUTOS ..'1_. ^
HIRED AUTOS
-X
WN090560
.-
03/14/12
03/14/13
X.
--PROPERTY—DAMAGE
(Per accident
- -
$
$
NON -OWNED AUTOS �"
_
E
UMBRELLA LIAB
OCCUR
..
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DEDUCTIBLE
$
$
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE[::]
TORY LIMITS ER
- "�- "---- - - ---
E.L. EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
NIA
E.L. DISEASE- EA EMPLOYEE
$
E.L. DISEASE- POLICY LIMIT
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
A
Motor Truck Cargo
WN090560
03/14/12
03/14/13
Limit $10,000
BROAD FORM
THEFT DDDDCTADLB $2,000.
Deduct $1, 000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more lace is required)
This certificate applies to the Schedule of Vehicles on file with the
insurance company. The Certificate Holder is named as Additional insured as
their interests may appear. Endorsement requested from the insurance company
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
215 No. Mason Street 2nd Floor
Fort Collins CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CZTYF04 I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
rem kY.ibbIII:LTe :7a:
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD