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463897 HENRY HERSH TRUCKING - INSURANCE CERTIFICATE (5)
HERSHT1 OP ID: MO ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) r05/22/15 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 Phone:801-943-2600 HUB Transportation (UT) P. O. Box 17346 Fax: 801-943-3889 CONTACT NAME: PHONE FAX A/C No Ext : A/C No): ADDRESS: Salt Lake City, UT 84117 Matthew D. Rex INSURERS AFFORDING COVERAGE NAIC # INSURER A: Northland Insurance Co INSURED Henry Hersh Trucking, Inc. INSURERB: 202 E. Vine Drive Fort Collins, CO 80524 INSURER C INSURER D : INSURER E : INSURER F : 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. NOTWI I'HSTANDING AN REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO vVHICH 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 I TYPE OF INSURANCE ADDLSUBR POLICY NUMBER EFF MM DDY/YYW L ICY EXP MMDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENT�_U PREMISES Ea occurrence $ 100,00 A X COMMERCIAL GENERAL LIABILITY X WF001033 06/01/15 06/01/16 CLAIMS -MADE J OCCUR MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,00 $ P POLICY RO LOC AUTOMOBILE LIABILITY COEa aMBINEDccidentSINGLE LIMIT 1,000,00 BODILY INJURY (Per person) $ A ANY AUTO X WFOO1033 06/01/15 06/01/16 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED X AUTOS AUTOS PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A WC STATU- OTH- T R LIMIT ER E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT 1 $ If yes, describe under DESCRIPTION OF OPERATIONS below QT-660-9472B521-TIL-13 09/14/14 B Motor Truck Cargo 09/14/15 Limit 1,000,00 Deduct 5,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Schedule of vehicles on file with company. Certificate Holder is named Additional Insured (endorsement ordered from company) CERTIFICATE HOLDER CANCELLATION CITYFO2 City of Fort Collins 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 1114A��2� bl�� © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD