HomeMy WebLinkAbout490880 INGRAM DRILLING INC - INSURANCE CERTIFICATE (4)OP ID: JA
'`'lam �' CERTIFICATE OF LIABILITY INSURANCE
DATE DIYYYY)
05/23/14
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 terns 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 970-223-1804
ValkBell Properly 8 Casualty
1100 Haxton Dr. Suite #100
Fort Collins, CO 80626
Steven G. Smith
��) O
CONTACT
PHONE FAX
A/C No EatI, A/L No):
E-MAIL
ADDRESS:
PRODUCER
CUSTOMER ID #: I NCiRA'2
INSURER(S) AFFORDING COVERAGE
NAIC 0
INSURED Ingram Drilling, Inc.
Stephen Ingram
P.O. Box 342
Estes Park, CO80517
INSURER A: Cincinnati Insurance Companies
10677
INSURER B: Plnnacol Assurance
41190
INSURERC:RSUlIndemnity Company
INSURER D :
INSURER E
NSURER 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
rypE OF INSURANCE
POLICY NUMBER
POLICYEFF
MM/DD/YYYYI
POUCYEXP
IMMIDDNYYY1
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,00
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE O OCCUR
EPP0201694
06/01/14
06/01/15
PREMISES Ea occurrence
$ 500,00
MED EXP (Any one person)
$ 10,00
PERSONAL B ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER,
PRODUCTS - COMP/OP AGG
$ 2,000,00
POLICY PRO-
JECTLOC
$
A
AUTOMOBILE
LIABILITY
ANYAUTO
EBA0201694
06/01/14
06/01/15
COMBINED SINGLE LIMIT
accident)
$ 1,000,00
X
BODILY INJURY
BODILY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
SCHEDULED AUTOS
HIRED AUTOS
PROPERTYDAMAGE
(Pereccidenl)
$
$
NON -OWNED AUTOS
E
X
UMBRELLA UAB X
OCCUR
EACHOCCURRENCE
$ 1,000,00
AGGREGATE
$ 1,000,00
A
EXCESS DAB
CLAIMS -MADE
EPP0201694
06/01/14
06/01/15
DEDUCTIBLE
g
X
$
RETENTION $ 10,000
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANVCER/MEETORIPARTNDED' CUTIVE YIN
OFFICER/MEMBER Min
NIA
4164640
06/01/14
06/01/15
WC STATU- OTH-
X T RY IMI TS ER
E.L. EACH ACCIDENT
$ 1,000,00
EL DISEASE -EA EMPLOYE
E 1,000,00
NH)EXCLUDED?
If endatoryin NH)
It yes, tlesvibe under
DESCRIPTION OF OPERATIONS Eelow
E.L. DISEASE- POLICY LIMIT
$ 1,000,00
A lEquipment
Floater
EPP0201694
06/01/14
06/01/16
LSd/Rnt 50,00
C lExcess
Liability
NHA235589
06/01/14
06/01/15
Excess 10,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, Kmom space is mqulmd)
City of Fort Collins
Purchasing
PO Box 580
Fort Collins, CO 80522
CITYOFF
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)
V 1966-ZUU9 ACOKU CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD