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Home My WebLink AboutDOUBLESTROKE TRUCKING LLC - INSURANCE CERTIFICATEFAX TRANSMITTAL SHEET ATTN: FROM: John Stephen - Purchasing Dept. Beth Isakson COMPANY: DATE: City of Fort Collins 9/24/201210:13:36 AM FAX NUMBER: SENDER FAX NUMBER: 9702216707 (970)506-6850 # OF PAGES INC. COVER: SENDER PHONE NUMBER: 3 (970) 506-3240 NOTES/COMMENTS: Please refer to the attached certificate for our insured. We are sorry you did not receive the previously sent cert as well as the actual endorsements to the policy. Please let us know if you need anything else or have questions. Thank you Beth The contents of this message sent from Flood & Peterson Insurance, Inc. is confidential, possibly privileged, and intended only for its addressee. If you have received this message in error, you must not disclose, copy, circulate, or in any other way use or rely on the information contained in this message. If you have received this message in error, please contact Flood & Peterson Insurance, Inc. by phone at 970-356-0123. Client#: 51490 DOUTR ACORD. CERTIFICATE OF LIABILITY INSURANCE ATE (MM D5/10/2012 ) 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 Flood B Peterson Ins., Inc. P. O. BOX 578 Greeley, CO 80632 970356.0123 CONTACT NAME: Beth Isakson PNGNE 970 356.0723 FAX 970 506.6850 Exl : ac, No E-MAIL ADDRESS: Beth.isakson@floodandpeterson.com CUSTOMER ID q: INSURER(S) AFFORDING COVERAGE NAIC 71 INSURED INSURER A: Great West Casualty Doubk:stroke Trucking LLC 1200 Crest Ct INSURER B: Windsor, CO 80550 INSURER C: 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 N R D POLICY NUMBER POLICY EFF MMMD POLICY MP MMIDDIYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CI-AIMS-MADEAj OCCUR GWP86978B 05/23/2012 05/23/2013 EACH OCCURRENCE $1,000,000 DAMAGE GET ER RENTED ence $100,000 MED EXP(Any one peen) $5,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRa LOC PRODUCTS-COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS GWP86978B 05/23/2012 05/23/2013 COMBINED SINGLE LIMIT aBIt $1,000,000 BODILY INJURY (Per perm) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Permcident) $ X X $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAI MSMADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE❑ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC STATU- OTH- T iRV LIMIT ER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ A Broad Form Cargo GWP86978B 05/23/2012 05/23/2013 $10,000 Per Unit $1,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Atltlllbnal Remarks Schedule, If more space Is required) City of Fort Collins is listed as an Additional Insured in regards to the General Liability and Auto Liability. City of Fort Collins Attn: Purchasing PO BOX 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD #S695528/M695523 MLU Page This page has been left blank intentionally.