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HomeMy WebLinkAbout107125 BIVENS TRUCKING & EXCAVATING - INSURANCE CERTIFICATE (2)OP ID: JA AFRO° CERTIFICATE OF LIABILITY INSURANCE °AT11/29%12YY' 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 NAMEACT VOIkBell Props •,t•.;, & Casualty — 1100 Haxton Dr. Julte #100 PHONE FAX IAJC. No Ext'(AID, No: EMAIL ADDRESS: Fort Collins, CO 80525 Kyle S Rehme I� PRODUCER BIVEN-1 CUSTOMER ID p INSURERS AFFORDING COVERAGE NAIC d INSURED Bivens Trucking & Excavating INSURERA:Secura Insurance Companies 22543 Aaron Bivens INSURER B: PInnacol Assurance 41190 862 W. Willox Ln. Ft Collins, CO 80524 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. NSR LTR TYPE OF INSURANCE ADDLSUBR &Iia POLICY NUMBER aOUC YEXP YYY POLICYYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR CP3145113 12/15112 12/15/13 ' EACH OCCURRENCE $ 1,000,00 PREMISES Ea=urmnce $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE X POLICY LIMIT APPLIES PER. PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $.. A AUTOMOBILE UABIDTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS A3145114 12/15112 12/15113 COMBINED SINGLE LIMIT accident) $ 1,000,00 X BODILY NJURY (Per person) BODILY INJURY $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ - $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER ECUTIVE YIN OFFICER/h1EMBER EXCLUDED? (Mandatory In NH) ❑yes, dmw, sunder DESCRIPTION OF OPERATIONS below NIA 3241983 08101/12 08/01/13 X WC STATU- OTH- E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE S 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 A A lProperty lEquipment CP3145113 CP3145113 12115112 12/15112 12115/13 12115113 BPP 50,00 led & Rnt 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AKaeh ACORD 101, Additional Remarks Schedule, If mom space Is required) CERTIFICATE HOLDER CANCFI. I ATION CITY OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Park Planning & Development Attn: Jason Stutzmen AUTHORIZED REPRESENTATIVE Box 580 Fort Fort Collins, CO 80522 � ACORD 25 (2009/09) ©1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD