HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (6)ACORD- CERTIFICATE OF LIABILITY INSURANCE
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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
P O Box 270370
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Fort Collins CO 80527
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURERA Zurich
Connell Resources Inc
INSURER B American International Companies
7785 Highland Meadows Pkwy
INSURER PlnnacolAssurance
Windsor CO 80528
INSURER D
INSURER E
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
INSR
TYPE OF INSURANCE
POLICY NUMBER
DA7EY E E
POLICYEXPIRATION
DATE
LIMITS
A
GENERAL LIABILITY
CP0375782405
06/01/08
06/01/09
EACH OCCURRENCE
$1000000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 51OCCUR
DAMAGE TO RENTED
$300OOO
MED EXP(Arty one parrs)
$10000
X PD Ded 5,000
PERSONAL & ADV INJURY
$1 000.000
GENERAL AGGREGATE
s2,000,000
GEN L AGGREGATE LIMIT APPLIES PER
POLICY X PRO LOC
JECT
PRODUCTS COMPIOPAGG
$2000000
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
CP0375782404
06/01/08
06/01/09
COMBINED SINGLE LIMIT
(Ea amident)
$1 000 000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
HIRED AUTOS
X
NON -OWNED AUTOS
BODILY INJURY
(Per amdent)
E
X
Drive Other Car
X
PROPERTY DAMAGE
(Per amdent)
$
GARAGE LIABILITY
AUTOONLV EAACCIDENT
$
ANY AUTO
OTHER THAN FA ACC
$
$
AUTO ONLY AGO
B
EXCESSIUMBRELLALIABILITY
X
OCCUR CLAIMS MADE
BE7275064
06/01/08
06/01/09
EACH OCCURRENCE
$5000000
AGGREGATE
$5 000 000
S
DEDUCTIBLE
RETENTION $ 1 OOOO
X
E
C
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY
4029651
06/01/08
06/01/09
X WCSTATU OTH
E L EACH ACCIDENT
$500000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
H yyea AL IR a antler
I'M "LPROVISIONSbelow
E L DISEASE EA EMPLOYEE
$500000
EL DISEASE POLICY LIMIT
s5000OO
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)
/ =MO IVI^AT� - -
City of Fort Collins
215 N Mason St
PO Box 580
Fort Collins CO 80522-0580
LID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL -3Q_ DAYS WRITTEN
E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL
IE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
ACORD 25 (2001/08) 1 of 2 #M416619
NIK 0 ACORD CORPORATION
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
ACORD 25S (2001/081 9 . f 7 NUA4&04e
ACORD- CERTIFICATE OF LIABILITY INSURANCE o5;Z9/ 8°"Y""'
PRODUCER
Flood & Peterson Insurance Inc
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR
4821 Wheaton Drive
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
P O Box 270370
Fort Collins CO 80527
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURERA Zurich
Connell Resources Inc
7785 Highland Meadows Pkwy
Windsor CO 80528
INSURER American International Companies
INSURER C Pinnacol Assurance
INSURER
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
INSIR
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE IMF DM CTIVEPDAITYEXPI
OTK)N
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX] OCCUR
X PD Ded 5,000
CP0375782405
06/01/08
06/01/09
EACH OCCURRENCE
$1 000 000
DAMAGE TO RENTED
$300 OOO
MED EXP (Any one person)
$1 O 000
PERSONAL B ADV INJURY
$1 000 000
GENERAL AGGREGATE
s2,000,000
GEN L AGGREGATE LIMIT APPLIES PER
POLICY F X PRO- LOC
PRODUCTS COMPIOPAGG
$2000000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON OWNED AUTOS
Drive Other Car
CP0375782404
06/01/08
06/01/09
COMBINED SINGLE LIMIT
(Ea amtlenp
$1000000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per acudent)
$
X
X
PROPERTY DAMAGE
(Per amdeni)
$
GARAGE LIABILITY
ANY AUTO
AUTOONLY EAACCIDENT
$
OTHERTHAN EA ACC
AUTO ONLY AGG
$
$
B
EXCESSIUMBRELLA
LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $ 10000
BE7275064
06/01/08
06/01/09
EACH OCCURRENCE
$5 000 000
X
AGGREGATE
$5 00O 000
$
X
$
C
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED+
If yes 4esmbe under
SPECIAL PROVISIONS below
4029651
06/01/08
06/01/09
TH
X WCSLIMTATU OER
E L EACH ACCIDENT
$500000
E L DISEASE EA EMPLOYEE
$500000
E L DISEASE POLICY LIMIT
$500000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE CRI# 2061010 Timberline Road Widening Project
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
215 N Mason St
2nd Floor
Fort Collins CO 80522
LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF THE ISSUING INSURER WILL KII099 MMAIL A0_ DAYS WRITTEN
CERTIFICATE HOLDER NAMED TO THE LEFT
ACORD 25 (20011091 4 . f 9 1HUI AR4T.
MIK
199E
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 endorsements)
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
^—�^-• --- '.,.,. ^..i c or c smaiooJa
ACORD- CERTIFICATE OF LIABILITY INSURANCE
05129,8°""YY'
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
P O Box 270370
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Fort Collins CO 80527
INSURERS AFFORDING COVERAGE
NAIC 9
INSURED ConINSURERA
Resources
Zurich
INSURER B American International Companies
7785 Highland
785 Highland Meadows Pkwy
INSURER C Pinnacol Assurance
Windsor CO 80528
INSURER D
INSURER E
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
IN
TYPE OF INSURANCE
POLICY NUMBER
DATE (MM CTW
DA Y DDNY N
LIMITS
A
GENERAL LIABILITY
CP0375782405
06/01/08
06/01/09
EACH OCCURRENCE
$1000000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx� OCCUR
DAMAGE TO RENTED
$30U QQQ
$1 Q 000
MED EXP (Any one Person)
X PD Ded 5,000
PERSONAL &ADV INJURY
$1 QQQ QQQ
GENERAL AGGREGATE
s2,000,000
GEN L AGGREGATE LIMIT APPLIES PER
POLICY X PRO LOC
PRODUCTS COMP/OP AGG
$2 QQQ QQQ
A
AUTOMOBILE
X
UMBILITY
ANY AUTO
CP0375782404
06/01/08
06/01/09
COMBINED SINGLE LIMIT
(Ea aoddent)
$1 QQQ QQQ
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per perm)
$
HIRED AUTOS
NON -OWNED AUTOS
X
DIY
(Perr aoddenRY)
$
X
Drive Other Car
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTOONLY EAACCIDENT
$
OTHER THAN FA ACC
AUTO ONLY AGO
$
ANY AUTO
$
B
EXCESSIUMBRELLA LIABILITY
X OCCUR CLAIMS MADE
BE7275064
06/01/08
06/01/09
EACH OCCURRENCE
$5 000 000
AGGREGATE
s5,000,000
$
DEDUCTIBLE
X RETENTION $ 10000
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4029651
06/01/08
06/01/09
X WO0RYUu OFT
E L EACH ACCIDENT
$500 OOO
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?E
I(yes ALd.PRO under
SPECIAL PROVISIONS bebr
L DISEASE EA EMPLOYEE
$500 000
EL DISEASE POLICY LIMIT
$500 000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE 2007 Asphalt Supply
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
215 N Mason Street 2nd Floor
Fort Collins CO 80522
I ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
IEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL An DAYS WRITTEN
TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL
NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
ACORD 25 (2001/08) 1 of 2 #M416619
NIK 0 ACORD
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 endorsements)
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
ACORD 25S (2001/081 9 of 9 wwneenn