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Home My WebLink About107125 BIVENS TRUCKING & EXCAVATING - INSURANCE CERTIFICATE (4)OP ID: JA A` o�sza CERTIFICATE OF LIABILITY INSURANCE Dar01/02/14vr) 1 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 CONTACT VolkBell Property & Casualty 1100 Haxton Dr. Suite #100 Fort Collins, CO 80525 Kyle S Rehme PHONE FAX ac o Eel; A/c No: EMAIL ADDRESS: PRODUCER , BIVEN-1 c INSURE S AFFORDING COVERAGE NAIL# INSURED Bivens Trucking & Excavating1 Aaron Bivens I 2 0I INSURERA:Secura Insurance Companies 2250 INSURER B: Pinnacol Assurance 41190 862 W. Willox Ln. Ft Collins, CO 80524 INSURERC: INSURER D : INSURER E : INSURER F : COVFRAGF_S 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 L TYPE OF INSURANCE POLICY NUMBER MM/DDNYYY MMOCDIYFY YY LIMms A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_] OCCUR CP3145113 12115113 12115/14 EACH OCCURRENCE S 1r000,0 PREMISE Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE X POLICY LIMIT APPLIES PER: F PRO LOC PRODUCTS - COMP/OP AGO $ 2,000,00 $ A AUTOMOBILE LMINLITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS A3145114 12/15/13 12/16/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peracuident) $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ It B WORK ERSCOMPENSATION qN0 EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE YE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 3241983 08/01/13 08/01114 X WCSTATU_TS- OTH- EL. EACH ACCIDENT $ 1,000,00 E.L. DISEASE -EA EMPLOYEE $ 1,000,OU E.L. DISEASE -POLICY LIMIT $ 1,000,00 A A Property Equipment CP3145113 CP3145113 IV15113 12115/13 12111114 12/15114 BPP 50,00 Led & Rnt 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) CITY OF City of Fort Collins Streets Department 625 9th St PO Box 580 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 U 1983.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD