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HomeMy WebLinkAbout498970 HILL PETROLEUM - INSURANCE CERTIFICATE (2)AC61? b® -CERTIFICATE OF LIABILITY INSURANCE 5/21/20 2 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 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 :,, --. Colorado BW Insurance' Agency, Inc. . -•." Db [. i.: - 12000 North Washington - $llite 201 Thornton --- - -- CO- 80241- -11/� CONTACT Jennifer Arnold, - r PHONE (303)451-5547 - - 1_ _ 'aC-Noll'(303)451-0605 - -- E-MAIL R -------- - -- - - -- - INSURE S AFFORDINGCOVERAGE - NAIC# INSURER A Travelers Cas Ins CoofAm -- 19046 - INSURED t�fl b Hill Enterprises, Inc., DBA: Hill Petroleum 6301 Ralston Road Arvada CO 80002 INSURERS:COntlnental Western-Grou -- — INSURER C:Pinnacol Assurance 41190 _ INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:CL1252139202 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DDMIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES fE. occunencel S 100,000 COMMERCIAL GENERAL LIABILITY A CLAMS -MADE OCCUR 105695682 10/1/2011 10/1/2012 MED EXP(An, one person) $ 5,000 PERSONAL BADV INJURY S 1,000,0001 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 2,000,000 S POLICY PRO LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT Ea Accident $ 1,000,000 BODILY INJURY (Per person) $ . 13 1 ANY AUTO - ALL OMED SCHEDULED AUTOS AUTOS CDP293685821 -10/1/2011 0/1/2012 BODILY INJURY (Par aciden0 $ PROPERTY DA E Per accident $ NON-OAMED HIRED AUTOS AUTOS Undednsured motorist $ 1,000,000 - }{ I UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 B EXCESS LIAR CLAIMS -MADE DIED RETENTIONS $ PU293686020 10/1/2011 30/1/2012 C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED' (Mandatory in NH) NIA 148287 6/1/2012 6/1/2013 X V4 STATU-OTH- LIMI E.L. EACH ACCIDENT $ 500,000 E. L. DISEASE - EA EMPLOYEE S 500,000 If as, describe under DESCRIPTION OF OPERATIONSI,ol W E.L. DISEASE - POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) jhume@£cgov.com City of Fort Collins Financial Services, Purchasing Division Jim Hume, Senior Buyer PO Box 580 Fort Collins, CO 80522 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Arnold/JAT—[?'r,_r..x�Lch, •�'r�n8-i.c�.� ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005),01 The ACORD name and logo are registered marks of ACORD