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Home My WebLink About128247 PIONEER SAND COMPANY INC - INSURANCE CERTIFICATE (23)30834 owrE (MN Donrrv) CERTIFICATE OF LIABILITY INSURANCE I ,/2/2014 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 pollcy(les) 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 Commercial Lines - (719) 592-1177 Wells Fargo Insurance Services USA, Inc. 5755 Mark Dabling Blvd., Suite 300 Colorado Springs, CO 80919-2228 INSURED Q Pioneer Sand Company, Inc ' 2 U 21+ PO Box 7650 Jill Russo, CIC, CISR ,. (719) 785.8133 Mutual Insurance Co. 1INSURERc: Pinnacol Assurance Company IN ,,,w,,,�o,,. Allian2 Global Risks US Insurance Co. 35300 Colorado Springs, CO 80933 I INSURER F: I I n Arcc nrerlclrwrcwwcco• 71350Q4 RFVIRInm M11uRFR• cm 6.1. 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. MaR TYPE OF INSURANCE KO I VIVO POLICY NM8ER POLICY EFF Y CD LATE A 0ENERAL UABHJ`rV X COMMERCIAL GENERAL LUIBILITY CLAIMSMAOE 7OCCUR TB2-Z91-439861-034 1/1/2014 1/1/2015 EACH OCCURRENCE $ 1,000,000 PREMISES RTE ME mrtence s 100,000 MED EXP ore S S,OOD PERSONAL A ADV INJURY S 1,000,000 GENERALAGGREGATE S 2,000,000 GENT AGGREGATE POLICY LIMIT APPLIES PER: FX I PRO. LOC PRODUCTS -COMPIOP AGO S 2.000.000 S A AUTOBILE LIABILITY MO X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS qAUTOS A152-Z91.439881-024 1/1/2)14 1/1/2015 CObnoED uMl 1.000.000 BODILY INJURY (Perpm m) $ BODILY INJURY (Pm YriEall) S PRERTY DAMAGE P S S B X UMBR11 UUAB EXCESBLAa X OCCUR CLAIMS -MADE T00001666004 111/2014 1/1/2015 EACH OCCURRENCE s 25,000,000 AGGREGATE S 25,000.000 DED x RETENTIONS 10.000 S C WORI(ERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOWPABTNERIEXECUTIVEO OFFICERIMEMBER EXCLUDEDT (Mandlory In NH) If yes d .ba under DESCRIPTION OF OPERATIONS bNow NIA 4018785 02/1/2014 02/1/2015 X WC STATU- OTH- E.L. EACH ACCIDENT 600,000 S E.L. DISEASE - EA EMPLOYEE E 500.000 E.L. DISEASE -POLICY LIMIT B 500,000 D D D Inland Marine/Property Leased/Rented Equipment Motor Cargo Legal Liability MX198476005 MX198476005 MX198476005 01/01rM14 01/01/2014 01/01/2014 01/01/2015 01/01/2015 01/01/2015 s1D,000,000 $ 1.oDo.000 $ loo,Doo DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (AUmbACORO101,Addlllonel RemA Schedule,NmphspR brow, ) RE: Bid #5148 Infield Soil Mix T, orArc Un, n1=0 rAMrF1 I ATInki City of Ft. Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Ft Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE ,e ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD V 1988-ZUI U ACUKU UUKPUKA I IUIY. Au ngni s reserved. 11111111111111N 1111111111111111 IE11111111111111111110 11111111111ea Anvm:z,uzmxNromo.