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Home My WebLink About109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (19)Client#: 14427 CONREI ACORa CERTIFICATE OF LIABILITY INSURANCE DATE""""" 5/31/2012 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: N the certificate holder Is an ADDITIONAL INSURED, the policy(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 certHlcate holder In lieu of such endoreement(a). PRODUCER Flood & Peterson Ina., Inc. P. O. Box 578 Greeley, CO 80632 97035"123 - LD CONTACT NAYS; Nikki Mosbrucker P"°NE 970 266-7123 FAX Att No EXI: A/C Na; 970 SGB-6823 ADORES:: nikkl.mosbrucker®floodandpeterson.com CUSTOM ID e: INSURERS AFFORDING COVERAGE NAIC4 INSURED Connell Resources, Inc. 7785 Highland Meadows Parkway #100 Fort Collins, CO 80528 INSURER A; Travelers Insurance Company INSURER 9: Pinnacol Assurance INSURER C: INSURER D: 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 REOUIREMENT, 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCEULBJL POUCYNUMBER POLICY EFF MM/D POLICY EXP MYRI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR DTC04794N532- IND13 6/01/2012 OSM112013 EACH OCCURRENCE $1 OOO OOO PREMISES Me occurnmel E3000OO MED EXP (My we pawn) $10000 PERSONAL& ADV INJURY $1 00O 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATEUMIr POLICY APPUESPEI: X PRO- LOC PRODUCTS-COMP/OP AGO $2000000 $ A AUTOMOBILE LIABILITY ANYAUTO ALLOWNEDAUTOSBODILY SCHEDULED AUTOS AUTOS NON -OWNED AUTOS Drive Other Car DT8104794N532- TIL13 6/01/2012 OSMJ/2013 COMBINED SINGLE UMR (Eaacdtlent) $1000000 BODILY INJURY(Per person) $ INJURY (Per accident) $ 1XXX PROPERTY DAMAGEHIRED (Per aWdent) $ $ $ A X UMBRELLA LIAR EXCESS LIAB )( OCCUR CLAIMS -MADE DTSMCUP4794N- 5321`I1-13 6/01/2012 06Ot/201 EACHOCCURRENCE $10000000 AGGREGATE $10000 000 R N ION $ HDEDUCIBLE X $ B WORXERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY OFFICERMEMBER EXC UDEED EC�� (Mandatory In NH) I ad.nI,e under , ARIPRON F PERATIONSbe NIA 4029651 W01M2012 06/01/201 X WCSTATLL I OTH. E.L EACH ACCIDENT ESOO OOO E.L DISEASE - EA EMPLOYEE $500 000 EL DISEASE - POLICY UMR $500000 DESCRIPnON OF OPERATIONS / LOCATIONS / VEHICLES (Anech ACORD 101, AWRlonal Remerb Schedule, N more epeoe Is required) RE: CRI#2121006 Locust & Peterson Waterline Repair City of Fort Collins Is Included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named Insured. City of Fort Collins 700 Wood STreet Fort Collins, CO 80522 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 ACORD 25 (2009/09) 1 Of 1 #S698978/M698847 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD M Clinntrk 14427 CONREI ACORM CERTIFICATE OF LIABILITY INSURANCE °5/31/2D°'Y""Y' 5/31/2012 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 CONSTTTU`TE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED, the polley(les) must be endorsed. If SUBROGATION IS WAIVED, sub)ect 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 certNlcats holder In lieu of such endoreement(s). PRODUCER Flood &Peterson Ina., Inc. P. O. Box 578 Greeley, CO 80632 970 356 0123 CONTACT NAME; Nikki Mosbrucker 266-7123 FAX ,Vc N,; 970 506-6823 PNC"No ii:�ikki.mosbrucker@floodandpeterson.com ADOREss: nikki.mosbrucker®fioodandpeterson.com C TOMER ID 1: INSURERS AFFORDING COVERAGE NAIC s INSURED INSURER A: Travelers Insurance Company Connell Resources, Inc. 7785 Highland Meadows Parkway #100 Fort Collins, CO 80528 INSURER BPlnnacoi Assurance INSURERC: INSURER D 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POUCYNUMBER MWDYEFF M�YEXP LIMA A GENERAL UABILm' X COMMERCIAL GENERAL LABILITY CLAIMS -MADE 51OCCUR DTC04794N532- IND13 6/01/2012 06/0112013 EACHOCCURRENCE $, OOOOOO PREMISES EAu...I s300000 MED UP (Any on. Parson) $10000 PERSONAL$ ADV INJURY $1 00O 000 GENERAL AGGREGATE $2,000 oO0 GEN'L AGGREGATE LIMIT APPLIES PER: 17 POLICY X PRO- LOC PRODUCTS - COMP/OP AGG $2000000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.O"ED AUTOS Drive Other Car DT8104794N532- TIL13 OMI/2012 06/01/201 COMBINED SINGLE UNIT (Ea emleent) $1000000 BODILY INJURY (Per perm) $ BODILY INJURY (Per acddmt) $ 1XXX PROPERTY DAMAGE (Peraaldent)$ $ $ A X UMBRELLA LIAR EXCESS LIAB Xd OCCUR CLAIMS -MADE DTSMCUP4794N- 532TIL13 6/01/2012 _. 06/01/2013 EACH OCCURRENCE $10Do- 0000 AGGREGATE $10 000 000 RETENTION $ HDEDUCTIBLE X $ B WORKERS COMPENSATION AND EMPLOYERS' LABILITY YIN ANY PR /MEMBERAEXARTNE T EC�� OFRCER(Mandatory In NH) If Yas, descnbe under DES RIPTI NOFOPERATIONSbeb WA 4029651 6/01/2012 06/01/2013 X WC STATU- orH- E.L EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $500000 E.LDISEASE - POLICY LIMIT 1$500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AtMch ACORD 101, Addltlonsl Remerb Schedule, It rare spew Is rsWInsa) RE: 7737 Asphalt Supply Services Agreement Certificate holder is named as additional Insured, but only as respects liability arising out of work (See Attached Descriptions) City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Purchasing DIVISIOn THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80522 I AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S698960/M698847 NIK rnnnt8•IAA97 CONREI ACORQ., CERTIFICATE OF LIABILITY INSURANCE DAy,'UNIDO2 n 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 CONSTfTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED, the policy(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 lieu of such endorsement(s). PRODUCER Flood & Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 970 356-0123 CONTACT NAME: Nikki Mosbrucker PHONE 970 288-7123 A c,.)..970 508 8823 Earl: ADDREss: nikki.mosbrucker@floodandpeterson.com gLiikki.mosbrucker@floodandpeterson.com CUSTOMERID e1 INSURER $ AFFORDING COVERAGE NAIC I INSURED Connell Resources, Inc. 7785 Highland Meadows Parkway #100 Fort Collins, CO 80528 INSURER A; Travelers Insurance Company INSURERS: Pinnacol Assurance INSURER C INSURER D 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1.111- TYPE OF INSURANCE POLICY NUMBER POLICY EFF MMID POLICY E%P MMID LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR DTC04794N532- IND13 SX11/2012 06/01/2013 EACH OCCURRENCE $1000000 PREMISES EEa u me 5300000 MEDEXP(A,mrn.Penen) $10000 PERSONAL &ADV INJURY $1,000 OOO GENERALAGGREGATE 52,000,000 GENL AGGREGATE LIMIT APPLIES PER: PR6 LOC POLICY )( JECT PRODUCTS - COMP/OP AGO $2000000 $ A AUTOMOBILE LIABILITY ANYAUTO ALLOWNEDAUTOS SCHEDULEDAUTOS HIRED AUTOS AUTOS Drive Other Car DT8104794N532- TIL13 6/01/2012 06/01/2013 COMBINED SINGLE LIMIT (Ea amide^') $1,000,000 BODILY INJURY(Per person) $ BODILY INIURY(Per amident) $ 1XXX PROPERTY DAMAGE (PeraWdant)NON-OWNED $ $ A X UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE DTSMCUP4794N- 532TIL13 6/01/2012 06/01/2013 EACHOCCURRENCE $10000000 AGGREGATE $1 O 00D 000 DEDUCTIBLE RETENTION $ X B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIV YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yae, describe under DE RIP ION OF OPERATIONS WIo, N/A 4029661 6/01/2012 OSM1/201 X WC STATU- OTH- E.L EACH ACCIDENT $600000 E.L DISEASE 2 EA EMPLOYEE $500 000 E.L DISEASE -POLICY LIMIT $500O00 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(Alheh ACORD 101, AW -I Renarb Schedule. N more apace is nMdW) RE: CRI# 2121002 - BRT Utilities Improvements Ph. 2 The City, Its officers, agents and employees are named as additional Insured, but only as (See Attached Descriptions) City of Fort Collins 700 Wood St Fort Collins, CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 01988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009I09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S698979/M698847 NIK