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HomeMy WebLinkAbout128247 PIONEER SAND COMPANY INC - INSURANCE CERTIFICATE (10)ACQRrf CERTIFICATE OF LIABILITY INSURANCE DATE(M/Y) 11/18/20102010 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 Commercial Lines - (719) 592-1177 Wells Fargo Insurance Services USA, Inc. 5755 Mark Dabling Blvd., Suite 300 CONTACT NAME: PHONE FAX A/C No): E-MAIL ADDRESS: PRODUCER 30834 CUSTOMER ID M Colorado Springs, CO 80919-2228 INSURERS AFFORDING COVERAGE NAIC # INSURED Pioneer Sand Company, Inc INSURERA: Liberty Mutual Insurance Co. 23043 INSURER B : Great American Insurance Company 16691 INSURER C : Pinnacol Assurance Pioneer Landscaping Materials, Inc INSURER D: Allianz Global Risk PO Box 7650 INSURER E : Colorado Springs, CO 80933 INSURER F : COVERAGES CERTIFICATE NUMBER: 2046583 REVISION NUMBER: See below 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rx-1 OCCUR TBJ-Z91-439861-031 1/01/2011 - 1/01/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED , PREMISES Eoccurrence $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ASK-Z91-439861-021 1/01/2011 1/01/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X — BODILY INJURY (Per person) -- $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ B UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE T000016660-01 1/01/2011 1/01/2012 EACH OCCURRENCE $ 25,000,000 AGGREGATE $ 25,000,000 DEDUCTIBLE RETENTION 10000 $ X $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4018785 2/01/2010 2/01/2011 X WC STIA�TU OTH- , E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEd $ 500,000 E.L. DISEASE - POLICY LIMIT I $ 500,000 D 0 D Inland Marine/Property Leased/Rented Equipment _T Motor Cargo Legal Liability MXI98474176 MX198474176 MX198474176 1/01/2011 1/01/2011 1/01/2011 1/01/2012 1/01/2012 1/01/2012 $10,000,000 $ 1,000,000 $ 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Bid #5148 Infield Soil Mix t:tK I ItII:A It MULLi City of Ft. Collins PO Box 580 Ft Collins, CO 80522-0580 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 (� 000858 The ACORD name and logo are registered marks of ACORD ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) I IIIIIII III IIIIIII IIII IIIII IIII1I IIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII 'CYB01AI81.00 4/02/02/0/0/0/0'