HomeMy WebLinkAbout- - (16) 75/30/2025
(MM/DD/YYYY)
A� CERTIFICATE OF LIABILITY INSURANCE
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 have ADDITIONAL INSURED provisions or 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 NAME:C Shana Tamayo
CRS Insurance Brokerage PHONE — - - FAX-------'
9780 S Meridian Blvd Suite 400 fAjc,No,Extle 303-996-7800 ac No:303-757-7719
Englewood CO 80112 AARESS: stamayo@crsdenver.com "!
INSURERS)AFFORDING COVERAGE NAIC#
_ INSURER A: Plnnacol Assurance w j 41190
INSURED MSDRI-1 INSURERS: Selective Ins.CO.Of America 12572
MS Drilling, LLC
4906 Dillon Street INSURERC:
Denver CO 80239 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER!14421090 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.
ADDLjSUBRI POLICY EFF I POLICY EXP --
LTR TYPE OF INSURANCE I IN WVD POLICY NUMBER ! MM/DD/YYYY MM/DD/YYYY LIMITS
B X COMMERCIAL GENERAL LIABILITY Y 1 S 2325702 6/1/2025 ; 6/1/2026 EACH OCCURRENCE $1,000.000
DA WUF TORENIEU
CLAIMS-MADE j X OCCUR ! PREMISES�Eaoccurrence $500,000
MED EXP(Any one person) $15,000
PERSONAL&ADV INJURY $1.000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
-- • -- [GENE - $2,000—,000
GR-GAT----- ------
PRO ------
POLICY'�XJ JECT LOC ;PRODUCTS-COMP/OP AGG $2,000,000
OTHER: -._..—._- $
_
B AUTO
MOBILE S 2325702 6/1/2025 6/1/2026 COMBINED SINGLE LIMIT $1,000,000
X 'ANY AUTO BODILY INJURY(Per person) $
OWNED F-7 SCHEDULED 1 AUTOS ONLY 1 AUTOS BODILY INJURY(Per accident)accident) S
X HIRED X~ NON-OWNED PROPERTY DAMAGE y
AUTOS ONLY AUTOS ONLY j Ler aecident�, _
$
B X UMBRELLA LIAB X ! OCCUR S 2325702 j 6/1/2025 6/1/2026 EACHOCCURRENCE $2,000,000
EXCESS LIAB CLAIMS•MAOEI i AGGREGATE $2,000,000
DED X i RETENTIONS S
q WORKERS COMPENSATION
4192972 1 6/1/2026 6/1/2026 !X PER OTH•
AND EMPLOYERS'LIABILITY y/N 1 STATUTE_ _ ER
ANYPROPRIETOR/PARTNEWEXECUTIVE I N/A E.L.EACH ACCIDENT E 1,000,000
OFFICER/ME MeEREXCLUDED?
N -- --
j(Mandatory In NH) �' j E.L.DISEASE-EA EMPLOYEE E 1,000,000
II yes,describe under
DESCRIPTION OF OF
below E.L.DISEASE-POLICY LIMIT $1,000,000
13 quipmrntFloeter - - - - -- i S 2325702 ; 6/.112025 ; 6/1/2026 Scheduled Equip Limit_ _ 258,432
ACV/Special Fonn Leased/Rented Equip - - 25,000
'., Deductible 1,000
I
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
The City of Fort Collins is included as additional insured on the General Liability with respect to ongoing and completed operations of the named insured for the
certificate holder as required by written contract.
CERTIFICATE HOLDER CANCELLATION
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
281 N College Avenue AUTHORIZED REPRESENTATIV
Fort Collins CO 80524 r.
01988.2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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