HomeMy WebLinkAbout128247 PIONEER SAND COMPANY INC - INSURANCE CERTIFICATE (24)ACORO®
`� CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
12/31/2014
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 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
The Wright Group, Inc.
1873 S Bellaire St Ste 600
Denver CO 80222
CONTACT Jill Russo
PHONE 719-354 4304 F" 719-354-4112
WC_N -
RE .jrusso@twgservices.com
INSURERS AFFORDING COVERAGE
NAIC M
INSURERA:EMC.
INSURED PIONE-1
INSURERB:PINNACOL ASSURANCE
INSURER C:Liberty Mutual Insurance Group
Pioneer Sand Company, Inc.
PO Box 7650
Colorado Springs CO 80918
INSURER D:GREAT AMERICAN
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1316439295 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
IN
WVD
POLICY NUMBER
POLICY EFF
MMIDD/YYYY
POLICY IDUP
MWDD
LIMITS
C
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FxI OCCUR
Y
Y 'TB2-Z91439861-064
12/31/2014
12/31/2015
EACH OCCURRENCE
$1000000
PRAEM SES l' ToEaEoccu once
8100000
MED EXP (Any one person)
$10,000
PERSONAL B ADV INJURY
$1000000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
OTHER:
GENERAL AGGREGATE
$2000000
PRODUCTS AGG
$2000000
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
ALTOWNED AUTOESULED
NON -OWNED
HIREDAUTOS AUTOS
Y
Y
5E23498
12/31/2014
12/31/2015
COMBINE I
Ea accitlent
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident)
$
D
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
Y
Y
TUU 016660-05
12/31/2014
12/31/2015
EACH OCCURRENCE
$25000000
AGGREGATE
1
$
DED I X I RETENTION$ 10,000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' UABILIN YIN
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDEDi ❑
(Myandatory in NH)
DESCRIPTION OF OPERATIONS below
NIA
y
018785
2/1/2014
2/1/2015
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
E500000
E.L. DISEASE- EA EMPLOYE
$500,000
E L DISEASE- POLICY LIMIT
$500000
A
Leased/Rented Equipment
Y
Y
5A23498
12/31/2014
12/31/2015
1000000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached U more space is required)
RE: Bid #5148 Infield Soil Mix
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ft. Collins ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
Ft Collins CO 80522-0580 AUTHORIZED REPRESENTATIVE
ACORD 25 (2014/01)
@ 1988-2014 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
001736