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HomeMy WebLinkAbout128247 PIONEER SAND COMPANY INC - INSURANCE CERTIFICATE (12)M834 ,4� �® CERTIFICATE OF LIABILITY INSURANCE DAT2/30/2nrrr) 12/30/2011 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(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 CONTACT Jill Russo, CIC, CISR NAME: Commercial Lines - (719) 592-1177 PHONE FAX .CAIC.No-E11 (719 )785-8133 INC. Nor. (719)592-0799 Wells Fargo Insurance Services USA, Inc. E-MAIL ADDRESS: I wellsfaro.ill.russo com @ 9 INSURER(S) AFFORDING COVERAGE NAIC # 5755 Mark Dabling Blvd., Suite 300 INSURER A: Liberty Mutual Insurance Co. 23043 Colorado Springs, CO 80919-2228 INSURED INSURER B: Great American Insurance Company 16691 Pioneer Sand Company, Inc " INSURER C Pinnacol Assurance PO Box 7650 INSURER D: Allianz Global Risk INSURER E INSURER F : Colorado Springs, CO 80933 COVERAGES CERTIFICATE NUMBER: 3766846 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 ADDCSUBRTYPE OF INSURANCE INSR MD POLICY NUMBER MM DD/YPOLICY EYYY MMIDDFF Y EXP LTR LIMITS A GENERAL LIABILITY MERCIAL GENERAL LIABILITY TBK-Z91-439861-032 01I01/2012 01/01/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 4-10M CLAIMS -MADE OCCUR MED EXP (Any one person) $ 5,000 PERSONAL X ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY r X PRO LOC $ A, AUTOMOBILE LIABILITY ASJ-Z91-439861-022 01/01/2012 01/01/2013 COMBINED SINGLE LIMIT arodentl 1,000,000 $ _(Ea BODILY INJURV(Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS JX BODILY INJURY (Per accitlenU $ PROPERTY DAMAGE PeraccigeJ $ NON -OWNED HIREDAUTOS AUTOS B XI UMBRELLA LIAR X OCCUR T000016660-02 01/01/2012 01/01/2013 EACH OCCURRENCE $ 25,000,000 AGGREGATE $ 25,000.000 EXCESS LIAB CLAIMS MADE DED X RETENTION$ 10000 $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE 4018785 02/1/2012 02/1/2013 X WC STATU- OTH- TQRY LIMITS. —_ER E.L. EACH ACCIDENT $ 500 coo OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $ W0,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASEPOLICYLIMIT $ 500,000 D D Inland Marine/Property Leased/Rented Equipment MX198476005 MXI98476005 01/01/2012 01/01/2012 01/01/2013 01/01/2013 $lo.000,Boo $ 1,0oo.000 D Motor Cargo Legal Liability MX198476005 01/01/2012 01/01/2013 s loo.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Bid #5148 Infield Soil Mix 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 The ACORD name and logo are registered marks of ACORD © 1 ACORD 25 (2010/05) 11111111111111111111111111111111111IN 11111111111111111111111111111111111111111111111111111 All rights reserved