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HomeMy WebLinkAbout107125 BIVENS TRUCKING & EXCAVATING INC - INSURANCE CERTIFICATE (17)BIVEN-1 OP ID: CT A� ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM2Y) _ 12/22/2017017 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 _NAME: 2002 Caribou Drive, Ste. 101 Fax. PHONE FAX A/C No Ext): _ _ (AIC. No): Fort Collins, CO 80525 E-MAIL Kyle S Rehme ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:CSU Producer Resources Inc 13037 INSURED Bivens Trucking 8r Excavating -- INSURERS: Cincinnati Insurance Companies 10677 Aaron Givens 862 W. Willox Ln INSURER C : Pinnacol Assurance 41190 Ft Collins, CO 80524 INSURERD: INSURER E : INSURER F : COVERAGES CFRTIFICATF NIIMRFR• RGVICInIJ M111u13Co• 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. INTR TYPE OF INSURANCE DDL UBR POLICY NUMBER EFF MM DPOLIDY/YYYY MM DDT LIMITS GENERAL LIABILITY EACH $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I X OCCUR X CSU0108579 12/21/2017 12/21/2018 A.AOCCURRENCE PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO X ENP0469281 12/15/2017 12/15/2018 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ ~J' UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY C ANY PROP RIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 3241983 12/01/2017 12/01/2018 WC STATU- OTH- TORY LIMITS R E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEO $ 1,000,00 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 B Property ENP0469281 12/15/2017 12/15/2018 BPP 50,000 B Equipment 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) City of Fort Collins is named as additional insured with regards to the General and Auto Liability policy(s). CERTIFICATE HOLDER CANCELLATION 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 — C�:�Ozv � © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD