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HomeMy WebLinkAbout107125 BIVENS TRUCKING & EXCAVATING INC - INSURANCE CERTIFICATE (16)BIVEN-1 OP ID: CT `��oEzo CERTIFICATE OF LIABILITY INSURANCE DATE(M 12/22/20YYY) /2017 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 CONTACT Front Range Insurance Group aHONE FAx - 2002 Caribou Drive, Ste. 101 Fax: A/c No A/C No): Fort Collins, CO 80525 EMAIL Kyle S Rehme ADDRESS: INSURED - Bivens Trucking & Excavating Aaron Bivens 862 W. Willox Ln Ft Collins, CO 80524 INSURER(S) AFFORDING COVERAGE t NAIC # INSURER A:CSU Producer Resources Inc 13037 INSURER8:Cincinnati Insurance Companies 10677 INSURER C : Pinnacol Assurance 41190 INSURER D : INSURER E : COVERAGES CERTIFICATE NUMBER- RFVISInN NIIMRFR- 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. INICY TR TYPE OF INSURANCE DDL SNUB POLICY NUMBER MM DD/YPOLICY EYYY EXP MMFF LDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CSU0108579 12/21/2017 12/21/2018 ATO PREMISES Eaoccurrence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY n PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ident Ea acc _ 1,000,000 BODILY INJURY (Per person) B X ANY AUTO ENP0469281 12/15/2017 12/15/2018 $ ALL OWNED SCHEDULED AUTOS AUTOS $ BODILY INJURY (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ H AGGREGATE EXCESS LIAB CLAIMS -MADE $ DID RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A 3241983 12/01/2017 12/01/2018 WC STOTH- RY LIMITMITS ER E.L. EACH ACCIDENT $ 1,000,00 $ 1,000,00 E.L. DISEASE- EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 B Property ENP0469281 12/15/2017 12/15/2018 BPP 50,000 B Equipment I ENP0469281 12/15/2017 12/15/2018 Lsd/Rent 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Fort Collins is named as additional insured on the general liability and auto liability. VCR I Ir ium I im rIVLUCR L,Ar4L.tLLA I IVIV CITOFFO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 582 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD