HomeMy WebLinkAbout490880 INGRAM DRILLING INC - INSURANCE CERTIFICATE (3)OP ID: CT
,4coR0 CERTIFICATE OF LIABILITY INSURANCE
DATE
06/05/2 Yol4
s/osna
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(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 endorsements .
PRODUCER Phone: 970-223-1804
CONTACT
VolkBell Properly & Casualty
1100 Haxton Dr. Suite #100 Fax:INC,Na
Fort Collins, CO BOS25
Steven G. Smith p
O
PHONE FAX
Est: aC Na:
E-MAIL
ADDRESS:
PRODUCER
CUSTOMER toe: I NGRA-2
INSURERS AFFORDING COVERAGE
NAIC e
V V V
INSURED Ingram Drilling, Inc.
INSURER A: Cincinnati Insurance Companies
10677
Stephen Ingram
P.O. Box 342
Estes Park, CO 80517
INSURERS: Pi nnacol Assurance
41190
INSURERC: RSUI Indemnity Company
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
POLICY EFF
MMIDDIVYYVJ
POLICY EXP
(MM1IXVYYYYI
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,00
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MHDE � OCCUR
EPP0201694
06/01/2014
06/01/2015
PREMISES Ea occurrence
$ 500,00
MED EXP (Any one person)
$ 10,00
PERSONAL B ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GENE AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,00
POLICY PRO
-
A
AUTOMOBILE
X
LUsJUUTY
ANY AUTO
EBA0201694
06/01/2014
06/01/2016
COMBINED SINGLE LIMIT
accident)
$ 1,000,00
BODILY INJURY
BODILY NJURY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
SCHEDULED AUTOS
HIRED AUTOS
PROPERTYDAMAGE
(Per eccidendent)Q
$
$
NON -OWNED AUTOS
$
BRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 1,000,00
TE
AGGREGATE
$ 1,000,00
A
CESSLIAB
CLAIMS -MADE
EPP0201694
06/0112014
06/01/2015
DUCTIBLE
$
$
TENTION $ 10,000
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICERIMEMBER EXCLUDED?
N / A
4164640
06/01/2014
06/01/2015
-
WC STATUOTH-
X V LI
E.L. EACH ACCIDENT
$ 1,000,00
E.L. DISEASE - EA EMPLOYEE
$ 1,000,00
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT I
$ 1,000,00
A
Equipment Floater
EPP0201694
06/01/2014
06/01/2015
Lsd/Rnt 50,00
C
Excess Liability
NMA235589
06/01/2014
06/01/2015
Excess 10,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is mqulmd)
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
1968-2009 ACORD CORPORATION All dnhre •nenrvnH
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD