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HomeMy WebLinkAbout446423 SJW TRUCKING INC - INSURANCE CERTIFICATE (2)SJWTR-1 OP 06 ACORO DATE (MM/DD/YYYY) �- CERTIFICATE OF LIABILITY INSURANCE 03/01/2018 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 have ADDITIONAL INSURED provisions or 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 970-674-8825 CONTACT Erich E. Ehrlich _ ME: The Insurance Store, Inc. PHONE g70-674-8825 FAX 970-674-8826 P O Box 174 A/C, No, Exq: 1 (A/C, No): Sidney, NE 69162 -M RIE : ee@reninsurance.com Dennis R. Hicks INSURED SJW Trucking Inc 11083 Hwy 14 Ault, CO 80610 C: Mutual Casualty Co INSURER E : INSURER F rnv�oAflCe fre0rI0If`ArI7 kitIRADCD• DGt/ICIrlilU IUI IMRGR• 415 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X .00CUR � Y i 5D82764 02/24/2018 02/24/2018 DAMAGE TO RENTED FMISFC fF�� Uffen _ 100,000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY = JECT1:1 LOC OTHER A AUTOMOBILE LIABILITY(Ea COMBINED SINGLE LIMIT aQizidenit) $ 1,000,000 BODILY INJURY Per rson $ ANY AUTO 5E82764 02/24/2017 02/24/2018 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY X AUTOS PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LU1B CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION ANDUTE EMPLOYERS' LIABILITY Y / N ECUTIVE PER OTH- T ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICERWEMBEER/EXCLUDED? ❑ (Mandatory In NH) N / A E.L. DISEASE - POLICY LIMIT If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Subject to policy forms, conditions, definitions and exclusions. City of Fort Collins is included as an Additional Insured with respect to General Liability & Auto Liability. CITYFTC City of Fort Collins PO Box 582 Ft 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD