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HomeMy WebLinkAboutDRILL PRO SERVICES INC - INSURANCE CERTIFICATEl._ R CERTIFICATE OF LIABILITY INSURANCE � DATE (MM DD/YYYY) 9/4/2013 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(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 CONTACT Channing Demonj a, CRIS NAME Moody Insurance Agency, Inc. 8055 East Tufts Avenue PHONE (303)824-6600 ..:'.. =.No.(303)370-0118 E-MAIL .cdemonja®moodyins.com Suite 1000 INSURERS AFFORDING COVERAGE NAICA INSURER A:Cincinnati Indemnity Company 23280 Denver CO 80237 INSURED INSURERS: Pinnacol Assurance 41190. INSURER C:OneBeacon Environmental Drill PLO Services, Inc. INSURER D: 2220 E. 74th Place Unit A INSURER E: Thornton CO 80229 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NtIMRFR- 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 POLICY NUMBER POLICY EFF MMIOD/YYYY I POLICY EXP MMMDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X EPP0208312 9/1/2013 9/1/2014 DAMAGE T N PREMISES Ea owarrence $ 50, 000 MED EXP (Any oneperson) $ 10,000 PERSONAL B ADV INJURY $ 11000,000 Additional Insured Form: GENERAL AGGREGATE $ 2,000,000 233CO05/11 (attached) GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 applies as required by POLICY X PRO_ RO LOG larritten contract. $ . AUTOMOBILE LIABILITY - CEO BBINEED SINGLE LIMIT _ 1,000,000 BODILY INJURY (Per person) $ _. AX: ANY AUTO.. .. ... ALL OWNED SCHEDULED AUTOS AUTOS X .. .. ... PP0208312 9/1/2013 9/1/2014 BODILY INJURY Per accident ( ) $ HIRED AUTOS X NON -OWNED AUTOS X PROPERTY DAMAGE Per accident •' $ $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ $ PP0208312 /1/2013 9/1/2014 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNERIEXECU➢VE OPFICERMEMBER EXCLUDED' (Myandatory in NH) If DESCRIPTIONOF OPERATIONS below N/A 16301246 - /l/2013 /l/2014 X WG STATIJ OTH- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYE $ 100,000 EL DISEASE -POLICY LIMIT $ 500,000 C Contractor's Pollution X 7930002730001 9/1/2013 9/1/2013 Limit: $ 2,000,000 Deduttble: $ 5,000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Ansel, ACORD 101, Additional Remarks Schedule, 8 more apace is required) City of Fort Collins is included as additional insured with respect to General and Automobile Liability as required by written contract, and Pollution Liability. City of Fort Collins Operations Services 117 N Mason 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) Demonja, CRIS/CBADE ©1988-2010 INS025 (201005).01 The ACORD name and logo are registered marks of ACORD All rinhts rosarvad