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Home My WebLink About107125 BIVENS TRUCKING & EXCAVATING - INSURANCE CERTIFICATE (6)OP ID: BS ,acoRO CERTIFICATE OF LIABILITY INSURANCE DATE (M0/20 YYY) 12/212016 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). PRODUCER Phone: 970-223-1804 NAME: NTACT VolkBell Property 8, Casualty 1100 Haxton Dr. Suite #100 Fax: Fort Collins, CO 80525 Kyle S Rehme PHONE FAX A/c IN Ertl: A/C No): E-MAIL PRODUCER CUSTOMER ID #: BIVEN-1 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Bivens Trucking & Excavating INSURER A:Secura Insurance Companies 22543 Aaron Bivens 862 W. Willox Ln. 41190 INSURER B : Pinnacol Assurance Ft Collins, CO 80524 INSURER 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 TYPE OF INSURANCE DL U POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY W MMIDD/YY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 A X COMMERCIAL GENERAL LIABILITY X CP3145113 12/15/2016 12/15/2017 CLAIMS -MADE Fx—1 OCCUR MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 �GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00POLICY PRO LOC A AUTOMOBILE X LIABILITY ANY AUTO X IA3145114 12/1512016 12/16/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS - $ BODILY INJURY (Per accident) SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ $ NON -OWNED AUTOS UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAB CLAIMS -MADE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA 3241983 08/01/2016 08/01/2017 X WC STATU- OTH- TORY LIMIT E.L. EACH ACCIDENT _ _ $ 1,000,000 E.L. DISEASE - EA EMPLOYE --_-- - $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 A (Property CP3145113 12/16/2016 12/15/1017 BPP 50,000 A (Equipment CP3145113 12/15/2016 12/15/2017 Lsd & Rnt 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS I 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 (2009109) The ACORD name and logo are registered marks of ACORD