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Home My WebLink About107125 BIVENS TRUCKING & EXCAVATING INC - INSURANCE CERTIFICATE (3)01/08/2008 09 58 9702233236 SKIES WEST PAGE 01 TE (NMIUp/YY) QR_l7 CERTIFICATE CF LIABILITY INSURANICE O1�D7,2ooB PRODUCER SKIES WEST IN$ AGENCY INC 1531 RIVERSID$ AVS UNIT A THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW SORT COLLINS, CO 80525 INSURERS AFFORDING COVERAGE INSURED INSURERA ALLIED GROUP BIVENS TRUCKING 6 EXCAVATING, INC INSURERS SINANCIAL INDEMNITY COMPANY 3900 IDEAL DRIVE INSURER USURER 0 -- I INSURER SORT COLLINS CO 80524- COVFRAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIC Y 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 AFF ORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPIE OF INSURANCE POLICV NUMBER POLIC.ATFYEFFECTWE POLICY EXPIRATION LIYRS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 FIRE DAMAGE (AR/ore Lire=E 50,000 A COMMERCIALGENERALLIABILITY I MED EXP AR' are pelwn) E 5,000 LJ CuUM5MA0E Fm OCCUR P GLO '1520061335 06/20/2007 06/20/2008 pERsoNAL snw INJURY E 1,000,000 ❑ GENERAL AGGREGATE S 2,000 000 GEN L AGGRI-.GATQ UNIT APPLIES PRODUCTS-COMPIOPAOG S 2,000,000 POLICY 0 P � I E—] LO(: AUTOMOBILE ❑ LU\B UTT ANY AUTO �~ COMBINED SINGLE LIMIT (Es acdeM) $ 11000,000 R ❑ ALL OWNED AUTOS SCHEDULED AUTOS — BODILY INJURY (p. Person) $ $ ❑ HIRED ALTOS NONIIVINIED AUTOS C7809975 03/16/20D7 03/16/2008 I90DILY INJURY 11 (Per eccltl ) ® TRUCIER" LIABILITY PROPERTY DAMAGE GARAGE LIABILITY (AUTO ONLY - EA ACCIDENT $ ANY Au TO OTHER THAN EA ACC ; $ AUTO ONLY AGO EXCESS LIABILITY EACH OCCURRENCE $ ❑ OCCUR CLAIMS MADE AGGREGATE $ $ $ DEOUCNBLE 1 i RETENTION 5 WORKERS COMPENSATION AND WG $TA OTH- EMPLOYERS' LIABILITY E L EACH ACCIDENT E EL DISEASE - EA EMPLOYEE $ EL DISEASE -POLICY LIMIT S OTHER , DESCRIPTION OF OPERAnONSILD MON91VEHICLEWEXCLUSION$ ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ATOITIONALINSURED. INSURER LETTER CANCELLATION SHOULD ANY OF THE AeOVE OEDDRIAED POUGES RE CANCELLED BEFORE THE EXPIRATION CITY OF FORT COLLINS 010 PORCHIASING' DRPT DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYSWR Ifl PO Box 580 NOTICE TO THE CERTIFICATE HOLDER, NAMED TO THE LEFT, BUT FAILURE TO 0090 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR FORT COLLINS CO 80522— REPRESEN TATIVCC AUTNO�WZFEOREPREREN7AJWE 221-6707 7(970) l Wv � S ACORD 25-3 (Iris?) ®ACC D CORPORATION IRS$ 01/07/2008 04.0013M Pinnacol Assurance PAGE 2 OF 3 ACOR CERTIFICATE OF LIABILITY INSURANCE °ITED1/0/2009 ` 3,lp]l2DpE PINNAER ASSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 7501 E Lao Den E Denver, CO80230-7006 wry Blvd Den AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER^ PINNAGOL ASSURANCE 41190 BIVENS TRUCKING & EXCAVATING INC 862W WILLOX LANE wsuRERe 1, SUuRERER FORT COLLINS, CO 80524 P OO INSURER E COVERAGES 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 DOCUMMENT 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 IN9R POCL POJCY EFFECTIVE PCUCI EXPIP410N LTR INSRO TIPEOFINBURNJCE POLICVNUMBER D1TE'AIAI/O0NyYVI RITE{MMOO/Vrvll LIMI78 OENERAL LIA81I EACH OCCURRENCE CAMA[E TO PC ITEO CC MMEPCIAL OENERAL U ARIUTY --I M9 HIDE 11 OCCUR PREMISES MED E%P,A"on• p•rso[ PER•LTPL 3Iw INJJFr ➢ENL AOGREOILE LIMIT APIPER 3ENERIL AGGREGATE PRODUCTS COMROP 100 POJCV nPRCLECi I _OC AUTOWBILE LIABILITY COMBINE] 9'NGLE UM1lli ANY 'LTD reh[vlGffR) B00ILV INJUR° ILLOANE] 4Ji09 ECHEOJLEDALTOS iP•r'-H, 1IIFEOAUT03 RIo LY INJURY NONOANE]AUTOS IP•1K od.H' PROIE171 CM A. P.rrs ne..nl GARAGE LIABILITY ALTOONLY EA ICCIOENT OTHER THAN EA ViC INV ALTO ILT'J OILI iG E 30E33NNHRELLA LIABILITY EApy OCCUPRENCE CCCLR CWM9M•➢E AGGREGATE DEDUCTIBLE DETENTION E WORKERS COW E NSATION ANO VIC STITU OTHER A EMPLOYERTLNIBILIR AN�PROPRIETORRARTNENf kEC'JTIlE 3241983 OSl01/2007 08l012008 TORT uInrcG E'_EACFACLIpEPIT $1 UOO OCO E LOIBEn9E E• EMPLOYEE $1 CCC CCO CFFlCERRIEM9ER E%C W ]EO' If yes pl•ese cn[!I[e ul'6•! PP'c CIPL PRGVI'IION9 pelpw E Lp19E•9E POUCV UM1lli $1,009 CCO OTHER DESCRIPTION OF OPIERATIONSILOCATIONSIVF HICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIPL PROVISIONS CERTIFICATE HOLDER CANCELLATION 1040209 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF FORT COLLINS PURCHASING THE EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR T P 0 BOX 580 MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Fort Collins CO 80522 LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OI LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE Nlchole Ellis ACORD 25(2001/08) Untlerwnter ACORD CORPORATION 1983 01/07/2008 04 OOPM Pinnacol Assurance PAGE 3 OF 3 CERTIFICATE HOLDER COPY CITY OF FORT COLLINS PURCHASING P O BOX 580 Fort Collins CO 80522 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) 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) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon