HomeMy WebLinkAbout128247 PIONEER SAND COMPANY INC - INSURANCE CERTIFICATE (8)100520
ACORD., CERTIFICATE OF LIABILITY
INSURANCE
DATE22/20/21209 Y)
09
PRODUCER Commercial Lines - (719) 592-1177
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Wells Fargo Insurance Services Mountain West Inc.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
5755 Mark Dabling Blvd., Suite 300
Colorado Springs, CO 80919-2228
INSURERS AFFORDING COVERAGE
NAIC #
INSURED Pioneer Sand Company, Inc
INSURER A: Wausau Underwriters Insurance Company
26042
INSURER a: National Union Fire Ins. CO. of Pittsburgh, PA
19445
Pioneer Landscaping Materials, Inc
PO Box 7650
INSURER C. Pinnacol Assurance
INSURER o: Fireman's Fund Insurance Company
21873
Colorado Springs, CO 80933
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 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE (MMIDD/YY E
PDATE MM/OD/YY N
LIMITS
A
GENERAL LIABILITY
TBJZ91439861039
1/01/2009
1/01/2010
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
$ 100.000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 7 OCCUR
MED EXP (Any one person)
S 5,000
PERSONAL S ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER
PRODUCTS -COMP/OP AGO
$ 2,000,000
17 POLICY X JECOT HOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
ASJZ91439861029
1/01/2009
1/01/2010
COMBINED SINGLE LIMIT
Be accident)
$ 20D0.000
X
BODILY INJURY
(Per Person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTOONLY EAACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
S
AUTO ONLY: AGG
B
EXCESSIUMBRELLA LIABILITY
BE 7275133
1/01/2009
1/01/2010
EACH OCCURRENCE
S 25.000,000
X I OCCUR F—ICI-AIMS MADE
AGGREGATE
S 25.000.000
S
$
DEDUCTIBLE
$
X RETENTION $ 10000
C
WORKERS' COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
4018785
2/01/2009
2/01/2010
WC
ORY UMIU- OTH-
T
E.L. EACH ACCIUEN
b 500A00
E.L DISEASE EA EMPLOYEE
$ 500.000
OFFICERIMEMBER EXCLUDED?
It yes. descnbe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$ 500. non
OTHER
D
Inland Marine/Property
MX198476005
1/01/2009
1/01/2010
$10,000.000
D
Leased/Rented Equipment
MX198476005
1/01/2009
1/01/2010
$ 1,000.000
D
Motor Cargo Legal Liability
MX198476005
1/01/2009
1/01/2010
$ 1oD,acD
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: Bid #5148 Infield Soil Mix
City of Ft. Collins
PO Box 580
Ft Collins. CO 80522-0580
LO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
IE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
aCnDn 9A e9nD1/nm • _u e
AUTHORIZED REPRESENTATIVE
,.� ar nDm r nIdDnDATIn KI 10CL
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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.
AcuKu zbs Izuuvual 2 of 2 #S915260/M915043