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Home My WebLink About491049 ORE CART TRUCKING - INSURANCE CERTIFICATE (3)ORECARI OP ID: DW ,acoRO CERTIFICATE OF LIABILITY INSURANCE kl� DATE(MMIDD/YYYY) 1 03/13/14 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 endorsements . PRODUCER Phone: 801-943-2600 ONTA T CNAM HUB Transportation (UT) P. O. Box 17346 Fax: 801-943-3889 Salt Lake City, UT 84177 Kevin R. Waldram IF PHONENo EMI: AK No: ADDRESS: INSURERS AFFORDING COVERAGE NAIC M INSURER A: Northland Insurance Co. NTU 24015 INSURED Teresa Adsit ^ dba: Ore Cart TTUCkInO �{ I p(( 5406 Fairway Six Drive Fort Collins, CO 80525 INSURERS: NSURER C: INSURER D: INSURER E : INSURER F : COVEFL r_cc CERTIFICATE NUMBER: REVISIONNUMBER: 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 POLICY NUMBER MWOD ICY EXP LILUDD UNITS GENERAL LIABILITY EACH OCCURRENCE S 2,000,00( EMISES Eaoccvnence S 100,0 A X COMMERCIAL GENERAL LIABILITY 141779 93/14N4 03I74115 MED EXP (Any one Person) $ 6,00 CLAIMS-MADE � OCCUR PERSONAL S ADV INJURY S 2,000,0 GENERAL AGGREGATE S 2,000, GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,00 S 1 POLICY PRO- 71 JECTLOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Es accident 2,000,00 BODILY INJURY (Par Pemm) $ A ANY AUTO - X 141779 03/14/14 03/14/15 BODILY INJURY (Per ecrJdent) i AALL UTOSMED X AUTO NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Peraccident S S UMBRELLA UAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIM CLAIMS -MADE DEC) I I RETENTION S WORKERS COMPENSATION VOCSTATU- 01H- I AND EMPLOYERS' LIABILITY YiN ANY PROPRIETOR/PARTNER/EXECUTIVE❑ El. EACH ACCIDENT S E.L. DISEASE -EA EMPLOYE S OFFICERIMEMBER EXCLUDED? (Mandatory In NH) NIA E.L. DISEASE -POLICY LWIT S n yea decaloe under DESCRIPTION OF OPERATIONS Mbw A Motor Truck Cargo 141779 03/14/14 03/14/15 Limit 10,00 BROAD FORM HEFT DEDUCTABLE $2,000 Deduct 1,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mom space Is required) This certificate applies to the Schedule of Vehicles on file with the insurance company. The Certificate Holder is named as Additional Insured as their interests may appear. Endorsement requested from the insurance company City of Fort Collins FAX 970-223-3576 215 No. Mason Street 2nd Floor Fort Collins, CO 80522 CITYF04 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 U 1988-ZUIU AUUKU I.UKHUKA I IUN. All rig Dts reserveu. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD