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HomeMy WebLinkAbout128247 PIONEER SAND COMPANY INC - INSURANCE CERTIFICATE (11)Q� A CC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 1/28/2011 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(les) 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: PHONENo, FAX iAIC.E-MAIL Exth A/C No: ADDRESS: PRODUCER 30834 CUSTOMER ID Colorado. Springs, CO 80919-2228 INSURERS AFFORDING COVERAGE NAIC # INSURED Pioneer Sand Company, Inc INSURER A: Liberty Mutual Insurance Co. 23043 INSURER e : 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: 2313606 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. I LT LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I—X-1 OCCUR TBJ-Z91-439861-031 1/01/2011 1/O1/2012 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 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- LOC POLICY 51 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 uMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ B X 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 YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4018785 2/1/2011 2/1/2012 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 D D D Inland Marine/Property Leased/Rented Equipment Motor Cargo Legal Liability MX198474176 MX198474176 MIX198474176 1/01/2011 1/01/2011 1/01/2011 1/01/2012 1/01/2012 1/01/2012 $10000000 $ 1:000:000 $ 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Bid #5148 Infield Soil Mix CERTIFICATE HOLDER 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 000962 The ACORD name and logo are registered marks of ACORD © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 11111111111111111111 IN 111111111111111 III1I 1111111111111111111111111 III1I 111111111111111111 •CYMIA01I..111.... 1.10/ ,e'