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Home My WebLink About490880 INGRAM DRILLING INC - INSURANCE CERTIFICATE (2)INGRA-2 OP ID: JW CERTIFICATE OF LIABILITY INSURANCE DA 05/21/13 ) 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(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 970-223-1804 VolkBell Property B Casualty 1100 Ha%ton Dr. Suite #100 Fort Collins, CO 80525 Steven G. Smith (r CONTACT NAME: PHONE FA% AIC No Ert : AIC No); EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAICd INSURER A: Cincinnati insurance Companies 10677 INSURED Ingram Drilling, Inc Stephen Ingram P.O. Box 342 Estes Park, CO 80517 INSURER B: PInnacol Assurance 41190 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, INSR LTR TYPE OF INSURANCE POLICY NUMBER MMIDDYIYYYY MMIDDUYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I -XI OCCUR EPP0194174 06/01/13 06/01/14 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 300,00 MED EXP(My one person) $ 10,00 PERSONAL S ACV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC PRODUCTS-COMPIOP AGG S 2,000,00 S A AUTOMOBILE LIABILITY - ANY AUTO ALL OVRJED SCHEDULED AUTOS AUTOS HIRED AUTOS X AUTOS AUTOS EPP0194174 06/01/13 06/01/14 COMBINED SINGLE LIMIT Ea acccent $ 1,000,00 X BODILY INJURY (Per person) $ INJURY (Per accitlent) $ X PROPERTY DAMAGE Per ao:Atlent 8 8 A X UMBRELLA LIAR E%CESS LIAR X OCCUR CLAIMS -MADE EPP0194174 06/01113 06101N4 EACH OCCURRENCE $ 11,000,00 AGGREGATE $ 11,000,00 DEB X RETENTION$ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDEDp (Mandatory In NH) f yes, describe under DESCRIPTION OF OPERATIONS od. NIA 4164640 06/01/13 06/01/14 X VJC STATU- OTH- T RYLIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E. L. DISEASE - EA EMPLOYEE $ 1,000,00 E. L. DISEASE -POLICY LIMIT $ 1,000,00 A A Property Section Equipment Floats EPP0194174 EPP0194174 06/01/13 06/01/13 06/01114 06/01/14 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more specs Is required) CITYOFF City of Fort Collins Purchasing PO Box 580 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 V1-M 1988-2010 ACORD CORPORATION_ All rights reserved ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD