HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (27)ACORD,>w CERTIFICATE OF LIABILITY INSURANCE 4/8/ta '
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
21 Wheaton Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
48
P 2 Box 270370 APR b 9 2004 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA: Zurich
Connell Resources, Inc. INSURERB: Pinnacol Assurance
4305 E. Harmony Road
INSURER C:
Fort Collins, CO 80528-9527 INSURER0:
INSURER E:
rnVFRACFS
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
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY FFECTI
D
PDATE Y M DDN N
LIMITS
A
GENERAL UABILITY ..
CP03757824
06/01/03
06/01/04
EACH OCCURRENCE
$1 000 000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
S300DOD
CLAIMS MADE 51OCCUR
MED EXP (Any one person)
$10 000
PERSONAL B ADV INJURY
$1 00O 000
X PD Ded:250
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
s2000000
POLICY PRO- LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
CP03757824
06/01/03
06/01/04
COMBINED SINGLE LIMIT
(Fa accident)
$1,000,000
X
BODILY INJURY
(per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Peratddent)
$
HIRED AUTOS
NON -OWNED AUTOS
//,,(��\j►
X
X
PROPERTY DAMAGE
(Per accident)
$
Drive Other Car
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GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
OTHER THAN EA ACC
AUTO ONLY: AGG
S
ANY AUTO
S
A
EXCESSIUMBRELLA LIABILITY
X OCCUR CLAIMS MADE
AUC3757825
06/01/03
06/01/04
EACH OCCURRENCE
$10000000
AGGREGATE
$1 O 00O 000
S
$
..
S
X1DEDUCTIBLE
RETENTION $1 O 000
B
WORKERS COMPENSATION AND
4029651
06/01/03
06/01/04
X WC STATU- OTH-
TORYLIMITS ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
E.L. EACH ACCIDENT
$500000
E.L. DISEASE - EA EMPLOYEE
$500,000
B yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
s500OOO
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: Bid# 5697 - Asphalt Supply Contract
Certificate holder Is named as additional Insured, but only as respects
liability arising out of work performed by the named insured (Excluding
Workers' Compensation).
City of Fort Collins
PO Box 580
Fort Collins, CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 2D_ 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
ACORD 25 (2001108) 1 of 2 #S278112/M248960 V NIK 0 ACORD CORPORATION 1988