HomeMy WebLinkAboutHENRY HERSH TRUCKING INC - INSURANCE CERTIFICATEA 6
A4CC) CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
k/31/2017
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 .
Utah -Hub International Transportation Insurance Se
CONTAPRODUCER NAME: m ary Ortiz
PHONE 800-748-5012 FAX . 866-436-4685
6440 Wasatch Blvd
Suite 235
E-MAIL TISCERTREQ anHubinternation al.com
INSURERS AFFORDING COVERAGE
NAIC #
Salt Lake City UT 84121
INSURERA:Northland Insurance Company
24015
INSURED HENRHER-01
INSURER B:The Travelers IndemnityCompany
25658
INSURER C
Henry Hersh Trucking, Inc.
INSURER D
202 E. Vine Drive
Fort Collins CO 80524
INSURER E
INSURER F :
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vTHIS 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 INSURANCEADDLISUBRI
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X❑ OCCUR
WN220756
6/1/2017
6/1/2018
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$100,000
MED EXP (Any one person)
$5,000
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS -COMP/OP AGG
$2,000,000
X POLICY1:1 PRO-LOC
JECT
$
OTHER:
A
AUTOMOBILE LIABILITY
VVN220756
6/1/2017
5/1/2018
'LE LIMIT
Ea accident
$1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
AUTOWNED X SCHEDULED
AUTONON-OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
HCLAIMS-MADE
DIED I I RETENTION $
$
WORKERS COMPENSATION
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYE
$
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory In NH)
NIA
E.L. DISEASE - POLICY LIMIT
$
-yes, de , iue under
DESCRIPTION OF OPERATIONS below
B
Motor Truck Cargo
QT 660 9472B521-TIL-17
9/14/2017
9/14/2018
Limit $1,000,000
Deduct. $5,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Schedule of vehicles on file with company. Certificate Holder is named Additional Insured (endorsement ordered from company)
CERTIFICA I E HULUEK 1 1v 1
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
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ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD