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HomeMy WebLinkAbout107125 BIVENS TRUCKING - INSURANCE CERTIFICATE (2)OP ID: CT ,acoKO CERTIFICATE OF LIABILITY INSURANCE D2/11/2 Y 1 1z/1 uol4 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 endorsemen s . PRODUCER Phone:970-223-1804 CONTACT VolkBell Property & Casualty 1100 Haxton Dr. Suite #100 Fax: Fort Collins, CO 80525 Kyle S Rehire PHONE FAX uC No Eau, A/c No): E-MAIL ADDRESS: PRODUCER BIVEN-1 CUSTOME0.ID p: INSURERS AFFORDING COVERAGE NAIC 0 INSURED Bivens Trucking & Excavating INSURER A:Secura Insurance Companies 22543 Aaron Bivens INSURER B:PInnacolAssurance 41190 862 W. Willox Ln. Ft Collins, CO 80524 NSURER 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, INSR LTR TYPE OF INSURANCE INSR MO POLICY NUMBER UPOLICY MIDD/YYYY WillYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 57 OCCUR X CP3145113 12/16/2015 12/15/2015 EACH OCCURRENCE $ 1,000,00 -DAIi RENTED PREMISES 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 LIMIT APPLIES PER: PRO LOC X POLICY FI JECT PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X A3145114 12/15/2014 12/15/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LUIB EXCESS LU' a OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION It S $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) Ryes, describe under DESCRIPTION OF OPERATIONS below NIA 3241983 08/01/2014 08/01/2016 X I WC STATU- I OTR- E.L. EACH ACCIDENT $ 1,000,00 E. L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 A A Property Equipment CP3146113 CP3145113 12/15/2014 12/15/2014 12/16/2015 12/15/2015 BPP 50,00 Led & Rnt 100,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Fort Collins is named as additional insured with regards to the General and Auto Liability policy(s). CITY OF City of Fort Collins Purchasing Department P.O. Box 580 Fort Collins, CO 80522 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 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD