HomeMy WebLinkAboutIN AND OUT PIPELINE - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCg OPID P6
NAND-1
DATE j/MiDD/YY)
01/14/05
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Inc - Ft Collins
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
125 S Howes, 5th Floor
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P O Box 2226
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
Fort Collins CO 80522-2226
Phone:970-482-7747 FSx:970-484-4165
INSURED
INSURER A: MOUNTAIN STATES MUTUAL
INSURERB: Pinnacol Assurance
INSURER C:
In and Out Pipeline LLC
INSURER D:
207 2nd Ave
LaSalle CO 80645
INSURER E:
COVERAGES
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.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDIYY
XPIRA
DATE MMIDD
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [K OCCUR
CPP007999903
01/02/05
01/02/06
EACH OCCURRENCE
$ 1, 000, 000
FIRE DAMAGE (Anyone fire)
$100,000
MED EXP (Any one person)
$ 10,000
PERSONAL B ADV INJURY
$1, 000, 000
GENERAL AGGREGATE
$ 2, 000, 000
GENT AGGREGATE LIMIT APPLIES PER:
POLICY X JPERC LOC
PRODUCTS - COMP/OP AGG
$ 2 , 0 0 0 , 0 0 0
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
BAP007999902
01/02/05
01/02/06
SINGLE LIMIT
COMBINED(Ea accident)
$ 1, 000, 000
BODILY INJURY
(Per person)
$
X
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
X
EXCESS LIABILITY
DEDUCTIBLE
X RETENTION $10,000
01/02/05
01/02/06
EACH OCCURRENCE
$3,000,000
AGGREGATE$
3,000,000
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4042682
05/01/04
05/01/05
TATU III
X I TORY LIMITS ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$ i, 0 0 0, 0 0 0
E.L. DISEASE -POLICY LIMIT
I $ 11 000, 000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Cert holder included as additional insured on commercial general liability
in policy form.
IIV VVVn y� AV VI�,V�ML�I�JVRCY: eFOY MLCI IC : V/V�yGL1..1\IIVI�
CITYFT5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City o f Fort Collins P O Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins CO 80522 REPRESENTATIVES.
1988