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HomeMy WebLinkAbout491049 ORE CART TRUCKING - INSURANCE CERTIFICATE (4)OREGAKI UP IU: UW CERTIFICATE OF LIABILITY INSURANCE 1 DATE03/19D/YYYY) 3/19115 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 endorsementtsl. PRODUCER Phone: HUB Transportation (UT) P. O. Box 17346 Fax: Salt Lake City, UT 84117 Kevin R. Waldram A: Northland Insurance Co. INSURED Teresa Adsit INSURERS dba: Ore Cart Trucking INSURERC: 5406 Fairway Six Drive Fort Collins, CO 80525 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER- RF=vlclnu kill IlIJI NAIC N 15 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. �� TYPE OF INSURANCE A POLICY NUMBER MMDDIYEYYY POLICYEXP MM DDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X WN164989 03/14/16 03/14/16 DAMAGE TO PREMISES Ea occurrence) $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,00 PRO 1-7 POLICYEI LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ee accident 1,000,00 BODILY INJURY (Per person) $ A ANY AUTO X WN164989 03/14/15 03/14/16 ALL OX SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident) $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE E EXCESS LWB CLAIMS -MADE DIED I I RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- , AND EMPLOYERS' LIABILITY Y I NI PROPRIETORMARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA ER TOLIMITSANY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yea, deaoribe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ A IMotor Truck Cargo WN154989 03/14115 03/14/16 Limit 10,00 (BROAD FORM THEFT DEDUCTIBLE $2,000 Deduct. 1,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more 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 for Auto & General Liability. Endorsement requested from the insurance company uya.�algyN CITYFO4 City of Fort Collins FAX 970-223-3576 215 No. Mason Street 2nd Floor 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 /I� I © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD