HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (3)ACORDrM CERTIFICATE OF LIABILITY INSURANCE 7/26/0;'°°' "''
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4821 Wheaton Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P 0 Box 270370
Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA: Zurich
Connell Resources, Inc. INSURER B: American International Companies
4305 E. Harmony Rd. INSURER C: Pinnacol Assurance
Fort Collins, CO 80528-9527
INSURER D:
INSURER E:
CAVFRAnFC
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATEYMM D
POLICY
MM/DDAI
LIMITS
A
GENERAL LIABILITY
CP0375782403
06/01/07
06/01/08
EACH OCCURRENCE
$1 000000
DAMAGE TO RENTED
a occurrence
$300 000
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
MED EXP (Any one person)
$10 000
PERSONAL & ADV INJURY
$1 000 000
X PD Ded:5,000
GENERAL AGGREGATE
s2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
POLICY X PRO LOC
JECT
A
AUTOMOBILE
LIABILITY
ANY AUTO
CP0375782403
06/01/07
06/01/08
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
X
X
PROPERTY DAMAGE
(Per accident)
$
Drive Other Car
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
B
EXCESSIUMBRELLA LIABILITY
BE7274938
06/01/07
06/01/08
EACH OCCURRENCE
s5,000,000
X OCCUR CLAIMS MADE
AGGREGATE
$5 000 000
$
DEDUCTIBLE
$
X RETENTION $ 10,000
C
WORKERS COMPENSATION AND
4029651
06/01/07
06/01/08
WC STATULIMT- I OTH-
X I
EMPLOYERS' LIABILITY
ANY PROI'RIETOR/PARTNEP./EXECU I-IVE
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYEE
s500,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
s500,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE: CRI# 2071031 - 5858 Miscellaneous Street Improvements
Certificate holder is named as additional insured, but only as respects
liability arising out of work performed by the named insured (Excluding
Workers' Compensation).
(See Attached Descriptions)
City of Fort Collins
215 N Mason St
PO Box 580
Fort Collins, CO 80522-0580
LATIUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL A( DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
TIVE
ACORD 25 (2001108) 1 of 3 #S388622/M385217 NIK O ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
AUUKU Z5-5 (2UU11M) 2 of 3 #S388622/M385217
11 DESCRIPTIONS (Continued from Page 1)
7126/07 NIK: mailed orig to cert holder; copy EM to Angie Bush
AM5 25.3 (200110s) 3 of 3 #53886221M385217