Loading...
HomeMy WebLinkAbout107125 BIVENS TRUCKING & EXCAVATING - INSURANCE CERTIFICATE (5)OP ID: BS AcoRO CERTIFICATE OF LIABILITY INSURANCEL:DAT�E(MMIDD/YYYY) 120/2016 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). CONTACT PRODUCER Phone: 970-223-1804 NAME: FAX ,VolkBell Property 8 Casualty Fax: PHONE (A/C_NOL 1100 Haxton Dr. Suite #100 E-MAIL Alc Extl: L Fort Collins, CO 80525 ADDRESS: — Kyle S Rehme PRODUCER BIVEN-1 cuSTOMER ID #: INSURER(S) AFFORDING COVERAGE E41 - — - 2543 INSURED BlvenS Trucking Excavating INSURER A:SeCUra Ir1SUranCe Companies Aaron Bivens INSURER B: Pinnacol Assurance 862 W. Willox Ln. INSURE"' Ft Collins, CO 80524 INSURER D INSURER E : - COVERAGES CERTIFICATE OF INSURANCE THE LIMITS NUMBER: REVISION LISTED BELOW HAVE BEEN ISSUED TO THE INSURED TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT INSURANCE AFFORDED BY THE POLICIES DESCRIBED SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP POLICY NUMBER MM/DD/YYYY MM/DDlYYYY CP3145113 12/15/2016 12/15/2017 NUMBER: NAMED ABOVE FOR THE POLICY PERIOD WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS THIS INDICATED. CERTIFICATE EXCLUSIONS NSR LTR IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY PERTAIN, AND CONDITIONS OF SUCH POLICIES. TYPE OF INSURANCE $ 1,000,OOI A GENERAL LIABILITY L GENERA X COMMERCIAL LIABILITY CLAIM -MADE OCCUR S a EACH OCCURRENCE PREMISES Ea occurrence $ 100,00( MED EXP (Any one person) $ 10,00I PERSONAL & ADV INJURY $ 1,000,00I GENERAL AGGREGATE $ 2,000,001 PRODUCTS - COMP/OP AGG $ 2,000,001 GEN'L AGGREGATE LIMIT APPLIES PER: $ X POLICY PRO LOC A3145114 12I1512016 12/15/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00i $ A AUTOMOBILE LIABILITY ANY AUTO X BODILY INJURY (Per person) BODILY INJURY (Per accident) $ ALL OWNED AUTOS PROPERTY DAMAGE (Per accident) $ SCHEDULED AUTOS $ HIRED AUTOS NON -OWNED AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR AGGREGATE $ $ DEDUCTIBLE e WORKERS COMPENSATION "- ^' """ "' "' AND EMPLOYERS' LIABILITY 08/01/2016 08/01/2017 E.L. EACH ACCIDENT $ 1,000 B 'NYOFFICERlMEMBER EXCLUDED? ECUTIVE Y❑ N / A 3241983 1,000 E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) 1,000 If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 12I7612016 12115/2017 BPP 50 q Property CP3145113 A Equipment CP3145113 121151 016 12115/2017 Lsd 8< Rnt 100 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) -ERTIFICATE HOLDER CANCELLATION CITY OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Streets Department AUTHORIZED REPRESENTATIVE 625 St PO PO Boo 580x 580 Fort Collins, CO 80522 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD