HomeMy WebLinkAbout498970 HILL PETROLEUM - INSURANCE CERTIFICATEACORO® ""CERTIFICATE OF LIABILITY INSURANCE
' DATE IMMI 1'1'YYI
� 9/27/2012
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 INSURE_R(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 tothe '
certificate holder in lieu of such endorsement(s): T- - - - -- - --
PR0000ER- --
Colorado BW-Insurance Agency, Inc. _ _ _ _ _
12000zNorth'47ashington !
Suite 20P`•.'t.rr•..r �. ez,,E
. -
Thornton _ CO_ _8_0,241 N
CONTACT Jennifer Arnold' - r -
NAME:
PHONE t, (303)451r5547 L _ -=.. q/CNot: (303) 451-0605 - -
E-MAIL -- - - - -- -- --
.- - - --- -, _--
INSURER(SI AFFORDING COVERAGE. --
. -NAIC #' V -
INSURER A:COntihental Western-GL'ouo- - -
-- '
INSURED'
Hill Enterprises, Inc., DBA: Hill Petroleum
6301 Ralston Road
Arvada CO 80002
INSURER 8-Plnnacol Assurance
41190
INSURER C:
INSURER D:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER:CL1292744911 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.
INSR
LTR
TYPE OF INSURANCE
ADDLSUBR
JUL.
ywo
POLICY NUMBER
POLICY EFF
MMIDDIYYYY)
POLICY EXP
(MMIDDIYYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
•
PREMISES Ea occurrence
$ 100,000
A
CLAIMS -MADE OCCUR
CDP293685821
10/1/2012
10/1/2013
MED EXP(My one person)
$ 5,000
PERSONAL B ADV INJURY
$ 1,000,000
_
GENERAL AGGREGATE -
$ - 2,000,000
GEN-LAGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO
$ 2,000,000
X POLICY PRO-- LOC
S--- --
AUTOMOBILE
LIABILITY' _ - - -
- -
-
COMBINED SINGLE LIMIT
Ea ad.dent -
"
- 1 000 -000
X
BODILY INJURY,(Per person)
$
A
ANY AUTO _ _
ALL OVMIED SCHEDULED
AUTOS AUTOS
_
DP293685821
10/1/2012
10/1/2013
-
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$. -
NON-OVMEED
HIREDAUTOS AUTOS
-
Undennsurad motorist
$ 11000,000
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
A
EXCESS LIAB
CLAIMS -MADE
DED RE7EMioN$
-
$
U293686020
10/1/2012
10/172013
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
X RC STATU- OTF+
LIMITANY
PROPRIETORIPARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$ 500,000
OFFICER/MEMSER EXCLUDED? El
(Mandatory in NH)
NIA
148287
6/1/2012
6/1/2013
E.L. DISEASE - EA EMPLOYEE
$ 500,000
If yes. desalbe under
DESCRIPTION OF OPERATIONS below
I
-
EL. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Adach ACORD 101, Additional Remarks Schedule, if more space is required(
jhume@fcgov.com
City of Fort Collins
Financial Services, Purchasing Division
Jim Hume, Senior Buyer
PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL EE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Jennifer Arnold/JATv
ACORD 25 (2010/05)
INS025 (201005).01 The ACORD name and logo are registered marks of ACORD
All rights reserved.