HomeMy WebLinkAbout490880 INGRAM DRILLING INC - INSURANCE CERTIFICATEClient# 25458
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ACORD.. CERTIFICATE OF LIABILITY INSURANCE
DATE 05/0912012Yn
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 certRlcate holder Is an ADDITIONAL INSURED, the pollcy(les) 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 Ileu of such endorsement(s).
PRODUCER
Flood & Peterson Ins., Inc.
P.O. Box 576
Greeley, CO 80632
970356-0123
NAME: Kelly Beauvais '
PHONE 970 356-0123 9705066836
NACANo Est: ABC, No:
ADDRESS kelly.beauvais@floodandpelerson.com
CUSTOMER ID
INSURER(S) AFFORDING COVERAGE
NAICA
INSURED
pp
INSURER A, The Hartford Insurance
30104
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Ingram Drilling, Inc. `x l0 0 p b
P O Box 342
INSURER 8:
Estes Park, CO 80517
INSURER C:
INSURER O:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR OTHER DOCUMENT WBH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY1-I'IE POLICIES DESCRIBED IIEREIN IS SUBJECT 10 ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSfl
LTP
rypE OF
DDL
NSR
UBR
YVD
POLICY NUMB ER
POLICY EFF
MMID IPYVVV
POLICY E%P
MMIDDIYY
OMITS
A
GENERALDABILITY
X COMMERCIAL GENERAL LIABIUW
CLAIMS -MADE OCCUR
04UUNOJ3239
0610112012
06/01/2013
EACHOCCURRENCE
$1 000 000
PREMISES Eaocwnwm)
s3000OO
MED EXP(MYone Person)
$10000
PERSONAL &ADV INJURY
$1000000
GENERAL AGGREGATE
s2,000,000
GEN'LAGGREGATE
POLICY
LIMIT APPLIES
J!TPRO
PER'.
LOC
PRODUCTS-COMP/OP AGG
$2000000
$
A
AUTOMOBILE
LIABILITY
ANYAUTO
ALLOWNEDAUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
04UUNOJ3239
6/01/2012
06/01/201
CO M BI NEDSINGLE LIMB
(Eeeccidenp
$1000000
X
BODILY INJURY (Per person)
$
BODILY INJURY(Per acadent)
$
1
PROPERTY DAMAGE
(Per acadent)
$
X
X
$
UMBRELLA DAB
EXCESS DAB
OC CUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
S
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILRY
ANY PROP RI ETORIPARTNE P/EXECUTIV E YIN
(Man Eatory In EXCLUDED?
If es dexrbe under
DESLIRI PTION OF OPERATIONS below
N/A
04WEOJ3731
6/01/2012
06/01/201
7( we STATU- OTH-
E. L. EACH ACCIDENT
$1000000
EL DISEASEEAEMPLOYEE
$1000000
EL.DISEASE -POLICY LIMIT
S7000000
DESCRI PTION OF OR ERATIONS I LOCATIONS I VEHICLES (Anach ACORD 101, Additional Romarke Bahedula, If more apace Is roqulmd)
City of Fort Collins
Attn: Purchasing
PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POUCI ES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
01988-20D9 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACERB
#S695370/MG95367 SXC