HomeMy WebLinkAbout463897 HENRY HERSH TRUCKING - INSURANCE CERTIFICATE (2)�Ro® CERTIFICATE OF LIABILITY INSURANCE OPID MO
OATE(MMIODYYVY)
08 01 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
UUNI
NAME:
PHONE
A/C, No, Eat: (A/C, No):
HUB Transportation (UT)
P. O. BOX 17346
Salt Lake City UT 84117
.-Ai
ADDRESS:
CUSTOMERIDN: HERSHTl
Phone:801-943-2600 Fax:801-943-3889
INSURER(S) AFFORDING COVERAGE
NAIC If
INSURED
Henry Hersh Trucking
202 E. vine Drive
INSURER A: Northland Insurance Co (SAC)
INSURER B: The Travelers Indemnity Co.
25658
INSURER c:
Fort Collins CO 80524
INSURER D
INSURER E :
INSURER F :
COVERAGES CtRTtriC-.ATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW ITAVE BEEN :COau Ion THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY f.OHTRACr,O W- "-
Jln[rt,7,;'/:QINENIV�Iin H'tSPtI.IIU WHICH 1Hi
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIO ES 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
INSRI
WV D
POLICY NUMBER
( MM/DDFULICII'YYY)�(M
TT
/M DD/V1'E1'VV)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
TF661680
06/01/12
06/01/13
EACH OCCURRENCE
OAMAGFTU1tENTEO
PREMISES (Ea occurrence)
$$1,000,000
$$100,000
MED EXP(Any one person)
$$5,000
PERSONAL B ADV INJURY
$$1,000,000
GENERAL AGGREGATE
$ $2, 000, 000
GEN'L AGGREGATE LIMIT APPLIES PER:
RLOG
POLICY Jpi
PRODUCTS - COMP/OP AGG
$$2,000,000
$
A
AUTOMOBILE
LIABILITY
ANV AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
TF661680
06/01/12
06/01/13
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNEWEXECUTIV
OFFICER/MEMBER E%CLUDEO?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
/ A
W TH-
TORY LIMITB ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
EL.DISEASE - POLICY LIMIT
$
B
Motor Truck Cargo
Reefer Brkdn
OT 660 9472B521-TIL-11
$100,000 LIMIT
09/14/11
09/14/1.3
Limit $1,000,000
Deduct. $5,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Schedule of vehicles on file with company.
CERTIFICATE HOLDER CANCELLATION
CITYFO2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
Purchasing Division
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522
ACORD 25 (2009109)
61968-YOV1 ACORD C601PORANIM.. All rights reserved.
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