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HomeMy WebLinkAbout128247 PIONEER SAND COMPANY INC - INSURANCE CERTIFICATE (13)308M '�� " CERTIFICATE OF LIABILITY INSURANCE pAT2/11/ 012 2/„/2D, 2 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 (719) 785-8133 FA% 719 592-0799 _(AC.. No,Est): EMAIL ill.russo wellsfar o.com ADDRESS: I g Wells Fargo Insurance Services USA, Inc. INSURERIS) AFFORDING COVERAGE NAIC k 5755 Mark Dabling Blvd., Suite 300 1 ,1 1 INSURERA: Liberty Mutual Insurance Co. 23043 c� Colorado Springs, CO 80919-2228 ,� p Vw� INSURED INSURER B: Great American Insurance Company 16691 Pioneer Sand Company, Inc INSURERC: Pinnacol Assurance Company 41190 PO Box 7650 INSURER D : Allianz Global Risks US Insurance Co. 35300 INSURER E : INSURER F : Colorado Springs, CO 80933 COVERAGES CERTIFICATE NUMBER: 5272316 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 TYPE OF INSURANCE INSR U D LTR POLICY NUMBER MMILDICPOLICEXP YYY MMIDDYIYYYY LIMITS A GENERAL LIABILITY X C4OMMERCIAL GENERAL LIABILITY TBJ-Z91-439861-033 1/1/2013 1/1/2014 EACH OCCURRENCE DAMAGE TO RENTED PREMISES Ea occunence)_ $ 1,000,000 $ 100000 _ CLAIMS -MADE � OCCUR MED EXP Any one person) $ 5000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 2,000,000 POLICY-X] PRO LOC $ A AUTOMOBILE LIABILITY _ ASJ-Z91-439861-023 1/1/2013 1/1/2014 COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOB BODILY INJURY (Per accitlenU $ PROPERTYDAMAGE Per accident!_ -$ NON -OWNED HIRED AUTOS AUTOS B X UMBRELLA LIAe X OCCUR TUU 001666003 1/1/2013 1/1/2014 EACH OCCURRENCE $ 25,000,000 AGGREGATE $ 25000,000 EXCESS LIAR CLAIMS -MADE DEL) I X I RETENTION$ loom $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA 4018785 02/1/2012 02/1/2013 X WC STATU- OTH- _TQRY_LIh9T5.I I ER_ E.L. EACH ACCIDENT g 500,000 E.L. DISEASEEAEMPLOYE E 500,000000 (Mandatory In NH) If re, descnbe undor DESCRIPTION OF OPERATIONS O E.L. DISEASE- POLICY LIMIT 500,eirm E D D Inland Marine/Property Leased/Rented Equipment MX19B476005 MX198476005 01/01/2013 01/01/2013 01/01/2014 01/01/2014 E1o,wo,ow $ 1,000,000 D Motor Cargo Legal Liability MXI98476005 01/01/2013 01/01/2014 $ l00000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) II II I I III II I I II I II II II II II I II I I I I I I III II III -CYaoIAI e00c58,e0=l0rrororo•