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HomeMy WebLinkAbout110453 HOUSKA AUTOMOTIVE SERVICES INC - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE r DATE(MM/DD/YYYY) 03/19/2013 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 CERTICATE 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 endorsements . PRODUCER YOUZOOm Insurance Services Inc. - 7045 College Blvd., 4th Floor CONTACT NAME: Arrowhead Automotive Aftermarket Service Center, HONE. Exr: 888-240-8803 F� No : 877-835-1833 Overland Park, KS 66211 Fax:877-835-1833; PH: 888-240-8803, Option 1 E-MAIL AMServiceCenter arrowhead r ADDRESS: 9 p'com INSURERS AFFORDING COVERAGE NAIC # INSURED 0128587-00 INSURERA: Universal Underwriters Insurance Company 41181 INSURER B: Universal Underwriters of Texas Ins. Co. 40843 HOUSKA AUTOMOTIVE SERVICES, INC.; DJ & N LEASING SERVICES, LLC; D & N HOUSKA FAMILY, LLC INSURER C: 899 RIVERSIDE AVENUE INSURERD: FORT COLLINS, CO 80524 INSURERE: 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. INSR LTR TYPEOFINSURANCE DD'L J= 3UBF MD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A LIABILITY ® COMMERICAL GENERAL LIABILITY ❑❑ CLAIMS MADE ® OCCUR ❑ _ ❑ — El ❑ 286827 04/01/2013 04/01/2014 EACH OCCURENCE $300,000 D rKe PREMISESA M GE TO RENTED $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP/OP AGO $ _ A AUTOMOBILE ❑ ❑ALL ® ® LIABILITY ANY AUTO OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS ❑ ❑ 286827 04/01/2013 04/01/2014 COMBINED SINGLE LIMIT His Accident) $30D,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERN DAMAGE Per acutlent $ $ ® NON -OWNED AUTOS A ® ❑EXCESS UMBRELLA LIAB ® OCCUR LIAB ❑ CLAIMS -MADE ❑ ❑ 286827 04/01/2013 04/01/2014 EACH OCCURRENCE $5,000,000 AGGREGATE $ ❑ DEDUCTIBLE PRODUCTS - COMP/OP AGO $ 15,000,000 $ ® RETENTION $ 0 WORKERS COMPENSATION AND WC STAW- OW - EMPLOYERS' LIABILITY ANY PROPRIEfORIPARiNERIIXECUTNE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under NIA❑ ❑ TORS LIMITS ❑ ER E.L. EAC H ACC IDENT $ - E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below A GARAGE LIABILITY F� ANY AUTO ❑ ❑ 286827 04/01/2013 04/01/2014 OTHER THAN AUTO ONLY EACH ACC: $300,000' A CUSTOMER AUTO -DIRECT PRIMARY ❑ ❑ 286827 04/01/2013 04/01/2014 $450,000Limit DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AHach ACORD 101, Additional Remarks Schedule, if more space is required) Reason for Certificate: TOWING AGREEMENT. See Additional Remarks Schedule Attached CERTIFICATE HOLDER CANCELLATION CITY OF. FORT COLLINS 215 NORTH MASON STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 580 ACCORDANCE WITH THE POLICY PROVISIONS. FORT COLLINS, CO 80522 Attn: AUTHORIZED REPRESENTATIVE. Fax: YouZoom Insurance Services Inc. ©1988-2010 ACORD CORPORATION, All rights reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. © 1988-2010 ACORD CORPORATION, All rights reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 0128587-00 LOC #: A`� o• ADDITIONAL REMARKS SCHEDULE Page_3_bf 3_ AGENCY NAMED INSURED - Youzoom Insurance Services Inc. HOUSKA AUTOMOTIVE SERVICES, INC.; DJ & N LEASING SERVICES, LLC; D & N HOUSKA FAMILY, LLC 899 RIVERSIDE AVENUE POLICY NUMBER 286827 FORT COLLINS, CO 80524 CARRIER NAIC CODE Universal Underwriters Insurance Company 47181 EFFECTIVE DATE: 04I01I2013 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate Of Liahilitv Insurance 089-Umbrella Limit Inclusive applies. — Completed Operations Aggregate of $900,000 applies to the Garage Liability. ACORD 101 (2008101) . ©2008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD