HomeMy WebLinkAbout463897 HENRY HERSH TRUCKING - INSURANCE CERTIFICATE-- -
�Fh® CERTIFICATE OF LIABILITY INSURANCE OP ID MO
OATE,MM/3/Y2
O5/2/12
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
UUNIAUI
NAME:
.... ...Tra_..
HUH nsportation (UT)
P. O. Box 17346
PHONE _
Nc,No:Erg:-
MAIL
ADDRESS:
Salt Lake City UT 84117
CUSTOMERID, HERSHT1
Phone:801-943-2600 Fax:801-943-3889
INSURER(S) AFFORDING COVERAGE
NAICN
INSURED ll�p` 1
�rff
INSURER A: Northland Insurance Cc (sAC)
INSURER B: The Tra„elere lode cy Co.
25658
Heny" Hersh Trucking
202 E. Vine Drive
INSURER C:
Fort Collins CO 80524
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.
LTR
TYPE OF INSURANCE
INSR
WVD'
POLICY NUMBER
(MMIDDIYYYY)
(MMPCITCY LDDNYYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
TF661680
06/01/12
06/01/13
EACH OCCURRENCE
$$1,000,000
PREMIS S(MMenbe)
$ $100,000
MED EXP(Any one person)
$$5,000
PERSONAL B ADV INJURY
$$1,000,000
GENERAL AGGREGATE
s$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO
ECT LOG
PRODUCTS - COMP/OP AGG
$$2,000,000
$
*
AUTOMOBILE
LIABILITY
ANYADTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
.._ .._._�,. �...,.
�.
_
TF661680
..
06/01/12
06/01/13
COMBINED SINGLE LIMIT
(Ea accident)
$11000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
}{
PROPERTY DAMAGE
(Per accident)
$
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMSMADEAGGREGATE
EACH OCCURRENCE
$
$
DEDUCTIBLE
RETENTION $
$
S
WORKERS COMPENSATION
ANOEMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNERIE%ECUTIVG�
OFFICER/MEMBER E%CLUDED9 u
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
IA
W6 AU- n-
TORV LIMITS I I ER
E.L. EACH ACCIDENT
8
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE -POLICY LIMIT
$
B
Motor Truck Cargo
Reefer Brkdn
QT 660 9472BS21-TIL-11
$100,000 LIMIT
09/14/11
09/14/12
Limit $1,000,000
Deduct. $5,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101, Additional Remarks Schedule, if more space is required)
Schedule of vehicles on file with company.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYFO2 I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
Purchasing Division AUTHORIZED REPRESENTATIVE
PO Box 580
Fort Collins CO 80522
All rights reserved
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD