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Home My WebLink About107125 BIVENS TRUCKING & EXCAVATING - INSURANCE CERTIFICATEOP ID: JA A�ORO' CERTIFICATE OF LIABILITY INSURANCE DAT11/29/12 Y) 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($), 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 endorsements . PRODUCER 970-223-1804 VolkBell Property & Casualty _- 1100 Haxton Dr. Suite #100INC,No Fort Collins, CO 80525 Kyle S Rehme rt \� 4V CONTACT PHONE FAx Ext , A/C No); E-MAIL ADDRESS: PRODUCER BIVEN-1 CUSTOME ID p: INSURERS AFFORDING COVERAGE NAIC p INSURED Bivens Trucking & Excavating Aaron Bivens 862 W. Willox Ln. Ft Collins, CO 80524 INSURER A:Secura Insurance Companies 22543 INSURER B: Pinnacol Assurance 41190 INSURER C: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ' 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 T TYPE OF INSURANCE POLICY NUMBER MMIODIYYYY MM/DD/YYYY LIMITS A GENERAL LIA81UW X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_] OCCUR X CP3145113 12/15/12 12/15113 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) S 10,00 PERSONAL &ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. X POLICY PRO- LOC PRODUCTS - COMPIOP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS A3145114 12/15/12 12/15/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per parson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccident) $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION S S $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVEYF7 OFFICER/MEMBER EXCLUDED? (Mandatory in Hill If yes do scribe under DESCRIPTION OF OPERATIONS below NIA 3241983 08/01/12 08/01/13 X WC STATU- OTH E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 A A Property Equipment CP3146113 CP3145113 12/15/12 12/15/12 12/15/13 12/15/13 BPP 50,00 Led & Rnt 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Fort Collins is named as additional insured. 970-221-6707 CITY OF City of Fort Collins Purchasing Division Attn:John Stephen PO Box 580 Fort Collins, CO 80522 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 i ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD OP ID: JA AFRO° CERTIFICATE OF LIABILITY INSURANCE DAT11/291/29 D/YYYY) 1/12 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 endorsements . PRODUCER 970-223-1804 VolkBell Properry &Casualty - 1100 Haxton Dr. Suite #100 Fort Collins, CO 80525 Kyle S Rehme CONTACT NAME, PHONE PA% AIC No Eat , AIC No E"MAIL - ADORESS: PRODUCER gIVEN-1 CUSTOMER,, INSURERS AFFORDING COVERAGE NAIC e INSURED Bivens Trucking & Excavating Aaron Bivens 862 W. Willox Ln. Ft Collins, CO 80524 INSURERA:Secura Insurance Companies 22543 INSURER B: Pinnacol Assurance 41190 INSURER INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 DO POLICY NUMBER (MMIODNYYYI iMMIDDITYYY1LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CP3145113 12115/12 12/15/13 EACH OCCURRENCE $ 1,000,00 PREMISES Eao rrence $ 100,000 MED UP (My one Person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECT PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS A3145114 12115112 12115113 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA DAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYER$' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPFRATIONSbelow NIA 3241983 08/01/12 08/01/13 X WC STATU- OTH- E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 I E.L. DISEASE -POLICY LIMIT 1 S 1,000,00 A A Property Equipment CP3145113 CP3145113 12/15/12 12/16/12 12/15/13 12/15/13 IBPP 50,00 ILsd & Rnt 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CITY OF City of Fort Collins Streets Department 625 9th St PO Box 580 Fort Collins, CO 80522 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD