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HomeMy WebLinkAbout495725 STEVE SCHMIDT TRUCKING INC - INSURANCE CERTIFICATE (2)ACORD CERTIFICATE OF LIABILITY INSURANCE REVISED °os/zozo z PRODUCER Serial # 114111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MACHANN INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 11160 NO. HURON, STE. 36 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NORTHGLENN, CO 80234 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: ACUITY A MUTUAL INSURANCE COMPANY STEVE SCHMIDT TRUCKING, INC. I LQ s�'� �C INSURER B: PINNACOL ASSURANCE INSURER C: P.O. BOX 740 1 INSURER D: WINDSOR, CO 80550.0704 INSURER E: COVERAGES 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 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. INSR LTR ADD'L NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICYEXPIRATION GATE MM/DOIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES (ETO a RENTED ) $ 100,000 CLAIMS MADE FTI OCCUR MED EXP (Any ore person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 A L68262 8/29/12 8/29/13 GENERAL AGGREGATE E 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,600,000 POLICY PELT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) E 1,000,000 X BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS L68262 8/29/12 8/29/13 X X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per acaCeniJ $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC It ANY AUTO $ AUTO ONLY. AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ E $ DEDUCTIBLE $ RETENTION E WORKER'S COMPENSATION AND - OT X TOWRC VSTATURI LIMITS IT B EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE OEXCLUDED? 4051302 1/1/12 1/1/13 EL EACH ACCIDENT $ 500,000 EL DISEASE - EA EMPLOYEE S 500,000 yFyFICER/MEMBER SPce under ECAL PROVISIONS below EL DISEASE -POLICY LIMIT S 500,000 LIMIT: $10,000 A]OTHER MOTOR TRUCK CARGO L68262 ................................ 8/29/12 ..................... 8/29/13 ..................... DEDUCTIBLE: $500 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER IS AN ADDITIONAL INSUREDS PER ATTACHED CG 2010 (7-04) ON THE GENERAL LIABILITY. ADDITIONAL INSURED STATUS INCLUDES AUTOMOBILE LIABILITY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN CITY OF FORT COLLINS PURCHASING DEPT. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL P.Q. BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR FT. COLLINS, CO 80522-0580 FAX: 970-221-6707 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 26 (2001108) © ACORD CORPORATION 1988