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HomeMy WebLinkAbout491048 MUDRUNNER TRUCKING - INSURANCE CERTIFICATE (2)AcoRo® CERTIFICATE OF LIABILITY INSURANCE DATE (M Y 03/09/2015 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 CONTACT NAME: JOHN C. BECKETT & ASSOCIATES, INC. l". EN.. E,n: (970) 484-2805 (VAC No); (970) 404-2ee5 220 Smith Street _ADDRESS: tin0beckettinsuraince.com PRODUCER I�J��M�pY RICHARDSON CUSTOMER ID ewe'-�- _ Ft. Collins CO 80524- INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A :NORTHLAND INSURANCE COMPANY 10194 LARRY RICHARDSON DBA MUDRUNNER TRUCKING INSURER B 3121 N COUNTY RD 19 INSURER c INSURER D INSURER E FORT COLLINS CO 80524- INSURER F COVERAGES CERTIFICATE NUMBER- REVISION NUMRFR- 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 POLICY E POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MWDDfY1'YY) (MMIDDIYYYY) LIMITS A GENERAL UAB'UTY Y 61366 3/15/2015 03/15/2016 EACH OCCURRENCE E 1.000,000 X COMMERCIAL GENERAL LIABILITY DAMA E ED PREMISES Ea occurrence $ 100,000 CLAIMS -MADE ® OCCUR / / / / MED EXP (Any one person) $ 51000 PERSONAL BADVINJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 / / / / E POLICY PRO- LOC / / / / —. $CT A AUTOMOBILE LIABILITY Y =161366 3/15/2015 3/15/2016 COMBINED SINGLE LIMIT $ 1.000.000 (Ea accident) BODILY INJURY (Per Person) $ ANY AUTO ALL OWNED AUTOS / / / / BODILY INJURY (Per accident) --- $ SCHEDULED AUTOS / PROPERTY DAMAGE $ HIRED AUTOS / / / / (Per accident) E NON -OWNED AUTOS / / / / $ $ UMB Sao RELLA LW) OCCUR O COVERAGE / / / / EACH OCCURRENCE $ AGGREGATE $ EXtiCc LY18 CLAIMS•MADE / / / / / / / / DEDUCTIBLE $ / / / / RETENTION $ $ WORAERS COMPENSATION O COVERAGE WC STATU- OTH- S' AND EMPLOYERLIABILITY YIN T RY E.L. EACH ACCIDENT , $ ANY PROPRIETORMARTNERIEXECUTIVE Jr / / / OFFICERIMEMBER EXCLUDED? ® NIA / / / / (Mandatory in NH) E.L. DISEASE • EA EMPLOYE E 0 yyes describe under / / / / - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT ' $ COVERAGE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AHach ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate holder is also additional insured per written contract on the General Liability and Auto arising out of the operations of the named insured. Vehicle is 1995 Kenworth W90 VIN: 1XKWDB9XOSS649318. CERTIFICATE HOLDER CANCELLATION (970) 221-6775 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF FORT COLLINS ACCOUNTING & PURCHASING DEPT AUTHORIZED REPRESENTATIVE PO BOX 580 ys FORT COLLINS CO 80522-0580 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS02512009091 The ACORD name and logo are registered marks of ACORD