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Home My WebLink About124167 STEELY TRUCKING INC - INSURANCE CERTIFICATE (7)From: Morgan Fugate At: Brown & Brown Insurance of Colorado FaxID: (970) 484-4165 To: City of Fort Collins Date: 9/21/2012 10:09 AM Page: 1 of 2 Phone: ( ) - Fax: Fax From: Morgan Fugate To: City of Fort Collins Pages: 2 Fax: (970) 221-6707 Date: 9/21 /2012 10:04:27 AM Phone: ( ) - Sublect: Cert. Confidential Note: Information in this facsimile is confidential and intended for use by the individual or entity named If you received this telecopy in error, please immediately telephone us and return the original via U.S. Postal Message: From: Morgan Fugate At: Brown & Brown Insurance of Colorado FaxID: (970) 484-4165 To: City of Fort Collins Date: 9212012 10:09 AM Page: 2 of 2 gCOR� CERTIFICATE OF LIABILITY INSURANCE OP ID FM 09/F 0,'M/DDM Y) 21/12 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 NAMEPHONE I-AX (A/C, No, Ext): (A/C, No): Brown & Brown Inc mi ADDRESS: 4532 Boardwalk Dr, Suite 200 Fort Collins CO 80525 CUSTOMERID#: STEEL-1 Phone:970-482-7747 Fax:970-484-4165 INSURER(S) AFFORDING COVERAGE NAIL INSURED INSURERA: Secure Insurance A mutual Co. 22543 Steely Trucking Inc P O Box 633 INSURER B: Pinnacol Assurance Company 41190 INSURER C: Wellington CO 80549 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 (MM/DDM'YY) (MM/DD/1'1'YY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSMADE OCCUR X CP31839672 09/27/12 09/27/13 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $100,000 MED FAR (Any one person) $ 10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY JET LOC PRODUCTS - COMP/OPAGO $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS$ A31839682 09/27/12 09/27/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X X A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU1839692 09/27/12 09/27/13 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DEDUCTIBLE I RETENTION $ 10,000 $ X $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below /A 475882 01/01/12 Ol/Ol/13 X - - TORV LIMITS ER E L. EACH ACCIDENT $100,000 E. L. DISEASE - EA EMPLOYEE $100,000 EL.DISEASE -POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins included as additional insured regarding commercial general liability as required by contract or permit - policy form CGT1000 (10-01) Fax#221-6707 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYF10 I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins 215 N. Mason St.- -- Tyler B. Allen ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD