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HomeMy WebLinkAbout110453 HOUSKA AUTOMOTIVE SERVICES INC - INSURANCE CERTIFICATE (2),AIR© CERTIFICATE OF LIABILITY INSURANCE DAT/ 02/17/17/2014 Y) 014 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 endorsement(s). PRODUCER YOuZOOm Insurance Services Inc. 7045 College Blvd., 4th floor CONTACT Arrowhead Automotive Aftermarket Service Center NAME: PHONE A/c No. EXT : 888-240$803 (FWAX C No): 877 835-1833 E-MAIL AMserviceCenter@arrowheadgrp.com ADDRESS: grp'com Overland Park, KS 66221 Fax:877-835-1833; PH: 888-240-8803, Option 1 INSURERS AFFORDING COVERAGE NAIC # INSURED 0128587-00 00453 INSURERA: Universal Underwriters Insurance Company 41181 INSURERS: Universal Underwriters of Texas Ins. Co. 40843 HOUSKA AUTOMOTIVE SERVICES, INC.; DJ & N LEASING INSURERC: SERVICES, LLC; D & N HOUSKA FAMILY, LLC INSURER D: 899 RIVERSIDE AVENUE FORT COLLINS, CO 80524 INSURERE: rnvcoAncc L`COTICICATC NI IMRCR• RFVISION NLIMFIFR" 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 TYPE OF INSURANCE ADDIL UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD LIMITS A GENERAL LIABILITY ® COMMERICAL GENERAL LIABILITY ❑❑ CLAIMS MADE ® OCCUR ❑ — ❑ — ❑ ❑ 286827 04/01/2014 04/01/2015 EACH OCCURENCE $300,000 PREMISESS DAMAGE ( RENTED Ea occurrence) $ IVIED EXP (Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PROJECT ❑ LOC - PRODUCTS - COMP/OP AGG $ A AUTOMOBILE ❑ ❑ ® ® LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS ❑ ❑ 286827 04/01/2014 04/01/2015 COMBINED SINGLE LIMIT (Ea Accident) s300,000 BODILY INJURY (Per person) $ (Per accident) $ PROPERTY DAMAGE PROPSBODILY TYDA Per accident $ $ ® NON -OWNED AUTOS ® UMBRELLA UAS ® OCCUR ❑ ❑ EACH OCCURRENCE $ 5,000,000 AGGREGATE $ A ❑EXCESS LIAB ❑ CLAIMS -MADE 286827 04/01/2014 04/01/2015 ❑ DEDUCTIBLE PRODUCTS-COMROP AGG $ 15,000,000 $ ® RETENTION $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER ECUTIVE YI N OFFICER/MEMBER EXCLUDED? ❑ N / A ❑ ❑ WC STATULIMIj TORY LIMITS ❑ O R ER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT A GARAGE LIABILITY AUTO ❑ ❑ 27 2868ANY 04/01/2014 04/01 /2015 OTHER THAN AUTO ONLY EACH ACC: $ 300,000* A CUSTOMER AUTO -DIRECT PRIMARY ❑ ❑ 286827 04/01/2014 04/01/2015 $ 450,000 Limit DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Reason for Certificate: Towing Agreement. See Additional Remarks Schedule Attached CERTIFICATE HOLDER CANGELLAI IUN CITY OF FORT COLLINS 215 NORTH MASON STREET 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 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 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 0128587-00 LOC #: ADDITIONAL REMARKS SCHEDULE Page_3_of_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 41181 EFFECTIVE DATE: 04/01/2014 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: roducts — Completed Operations Aggregate of $900,000 applies to the ndorsement 089-Umbrella Limit Inclusive applies. e Liability. ACORD 101 (2008/01) © 2008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD