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HomeMy WebLinkAbout128247 PIONEER SAND COMPANY INC - INSURANCE CERTIFICATE (22)308M A� �® CERTIFICATE OF LIABILITY INSURANCE DAT2/112D/YYYY) 2 1/2013 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 JIII Russo, CIC, CISR NAME: Commercial Lines - (719) 592-1177 PHONE (719) 785-8133 �a 719 592-0799 E-MAIL ill.russo wellsfar o.com ADDRESS: I @ 9 Wells Fargo Insurance Services USA, Inc. INSURERS) AFFORDING COVERAGE NAIC 0 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 0 INSURER C : 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: 5552706 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 ADDL THEIR WEFFPOLICY EXP LTHEIR D POLICY NUMBER MMIDO/YYYY MM/DDLIMITS A GENERAL LIABILITY MERCIAL GENERAL LIABILITY TBJ-291-439861-033 1/1/2013 1l1 /2014 EACH OCCURRENCE DAMAGETORENTED_PREMISES (Ea occurrence)_ $ 1,000,000 $ 100.000 MEDEXP(Anyoneperson) $ 5.000 t_XCOM CLAIMSMADE� OCCUR PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PRO LOC S A AUTOMOBILE LIABILITY ASJ-Z91-439861-023 1/1/2013 1/1/2014 COMBINED SINGLE LIMIT Ea actitlenl 1.000,000 x DODILV INJURY (Par parson) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per actitlenl) $ PROPERTY DAMAGE $ NON -OWNED HIRED AUTOS AUTOS _{Peramidenl) $ B % UMBRELLA UAB X OCCUR TUU 001666003 1/1/2013 1/1/2014 EACH OCCURRENCE $ 25.000,000 AGGREGATE $ 25,000,000 EXCESS LIAB CLAIMS -MADE DED I % RETENTION$ 10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE 4018785 02/1/2013 02/l/2014 % I WC STATU- OTH- TORYLIMITS ER E.L. EACH ACCIDENT $ wo'" OFFICERIMEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ 500,000 (Mandatory In NH) If yes. If scribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 D D Inland Marine/Property Leased/Rented Equipment MX198476005 MX198476005 01/01/2013 01/01/2013 01/01/2014 01/01/2014 $1o,000,000 $ I000,000 D Motor Cargo Legal Liability MXI98476005 01/01/2013 01/01/2014 $ 1oo,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace Is requlmd) 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 00e109 The ACORD name and logo are registered marks of ACORD @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1II111111111111111 IIII Hill 1111111111111111111111111Hill 11111 1111111111111111111111111111111111111