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HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (34)Client#: 14427 CONREI ACORD.CERTIFICATE OF LIABILITY INSURANCE PATE O527I20127/20IY4 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 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 NAME: Nikki MGsbrucker Flood ♦i< Peterson ins., Inc. PHONEo 970 266-7123 her.970 506.6823 AIC NEat: AIC P. 0. BOX 578 E-MAIL ADDRESS: nmosbrucker@floodpeterson.com Greeley, CO 80632 INSURER(S) AFFORDING COVERAGE NAIC# 970356-0123 , INSURER A: Travelers Insurance Company INSURED INSURER B : Plnnacol Assurance Connell Resources, Inc. 7785 Highland Meadows Parkway #100 INSURER C: Fort Collins, CO 80528 INSURERD: 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 CONTRACTOR 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. INBR LTR TYPE OF INSURANCE ADDLSUBR INSR MD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYVY LIMITS • GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY GI -AIMS -MADE O OCCUR X X DTC04794N532- IND14 6/01/2014 06/01/2015 EACH OCCURRENCE $1 000000 RRMAISJJJ Eac&Eamce s300 DDD MED EXP (Any one poser) $10 000 PERSONAL B ADV INJURY $1,000000 GENERALAGGREGATE $2,000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC PRODUCTS - COMPIOP AGG $2,000,000 E A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS OS AUT HIRED AUTOS X NON OWNED AUTOS X X DT8104794N532- TIL14 0G10112014 061011201 EOM81NEEDISINGLE LIMIT $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per actl) dem $ X PROPERTY DAMAGE Per accident) S $ A X UMBRELLA LIAR EXCESS LIA9 X OCCUR CLAIMS -MADE X X DTSMCUP4794N532- TIL14 f Follows Form 6/01/201406101/201 EACH OCCURRENCE $10000000 AGGREGATE S10,000,000 DED I I RETENTIONS I $ B WORKERS COMPENSATION ANDEMPLOYERTLIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? � (Mandatory In NH) be under DESCRIPTION OF OPERATIONS ealoa NIA X 4029651 6/01/2014 06/01/2015 X WCSTATU- OTH- ER E.L. EACH ACCIDENT $SOO OOO E.L. DISEASE - EA EMPLOYEE $500000 E. L. DISEASE -POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Re: CRI# 2141014 - Plum Street Sewer Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S893317/M892257 NIK Client#: 14427 CONREI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYYI 05/27/2014 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 endorsement(s). PRODUCER N NAME: Nikki Mosbrucker Flood 8: Peterson Ins., Inc. PHONE 970 266-7123 A 970 506-6823 AIC No Ell: A/C No P. 0. Box 578 E-MAIL nmosbrucker@floodpeterson.com Greeley, CO 80632 970 356-0123 INSURER(S)AFFORDING COVERAGE NAIGp INsuRERA:Travelers Insurance Company INSURED INSURER B : Plnnacol Assurance Connell Resources, Inc. 7785 Highland Meadows Parkway #100 INSURER L: Fort Collins, CO 80528 INSURERD: 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 DDLSUB INSR M POUCYNUMBER POLICY EFF MWDD/YYYY POLICY EXP MMIDD LIMITS A GENERALLIABIDTY X COMMERCIAL GENERALDABILITY CLAIMS -MADE 4 OCCUR X X DTC04794N532- IND14 6101/2014 06101/2015 EACH�OCCURRENCE S1 000000 BREMISES EacwEnmce $300000 MED EXP (Any one person) $1 O 000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC PRODUCTS - COMP/OP AGG $2,000,000 I S A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOSBODILY HIREDAUTOS X NON -OWNED AUTOS X X DT8104794N532- TIL14 6/01/2014 06/011201E COMBINED SINGLE LIMIT Ea accident E1,000,000 BODILY INJURY(Per parson) S IX INJURY (Per aaidenQ S PROPERTY DAMAGE Per accident $ S A UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE X X DTSMCUP4794N532- TIL14 Follows Form 0610112014 06/01/2015 EACH OCCURRENCE S10 000 000 AGGREGATE $1000O 000 DIED I I RETENTIONS S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINER ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, desmbe under DESCRIPTION OF OPERATIONS below NIA X 4029651 6/01/2014 061011201 X WCSTATU- OTH- E.L. EACH ACCIDENT issOO 000 E.L. DISEASE -PA EMPLOYEEI $500 000 E. L. DISEASE -POLICY LIMIT 1 $600,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: CRI# - Annual Snow & Ice Removal The City, its officers, agents and employees are named as additional insured, but only as respects liability arising out of work performed by the named insured. A waiver of subrogation applies. City of Fort Collins 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 ACORD 25 (2010/05) 1 of 1 #S8933121M892257 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NIK Client#: 14427 CONREI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 05/27/2014 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 endorsement(s). PRODUCER CONTACT Nikki Mosbrucker NAME: Flood & Peterson Ins., Inc. PHONE FAX Arc No Ell: 970 266.7123 IC, No): 970 506-6823 P. O. Box 578 EMAIL ADDRESS: nmosbrucker@floodpeterson.com Greeley, CO 80632 INSURERIS) AFFORDING COVERAGE NAICN 970356-0123 INSURER A: Travelers Insurance Company INSURED INSURER B: Plnnacol Assurance Connell Resources, Inc. 7785 Highland Meadows Parkway #100 INSURER : Fort Collins, CO 80628 INSURERD: INSURERS: 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 CONTRACTOR 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 ADDLSUBR INSR IN POLICY NUMBER POLICYEFF MWDDIri POLICYEXP MMIDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERALLIABILIry CLAIMS -MADE 51 OCCUR X X DTC04794N532- IND14 061011201406/011201 EACH OCCURRENCE E1000 000 PREMISES E.MErrmce E300000 MED EXP (Any one person) E 1 O 000 PERSONAL S ADV INJURY E 1000 000 GENERAL AGGREGATE E2,000,000 GEN'L AGGREGATE POLICY X LIMIT APPLIES PER: JEPROC LOC PRODUCTS - COMPIOP AGO E2,000,000 E A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON-0WNED AUTOS X X DT8104794N532- TIL14 6/01/2014 06/0112015 COMBINED ISINGLE LIMIT E1,000,000 X BODILY INJURY (Par person) 5 BODILY INJURY (Per acatlenl) $ X PROPERTY DAMAGE Per acatlenl $ S A )( UMBRELLA LIAB EXCESS LIAB J( OCCUR CLAIMS -MADE X X DTSMCUP4794N532• TIL14 Follows Form 0610112014 0610112015 EACH OCCURRENCE $10000000 AGGREGATE $1000O 000 DED I I RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVEYIN OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below N/A X 4029651 6/11/2014 06/011201 X WCSTATU- OTH- E. L. EACH ACCIDENT $SOO OOO E.L. DISEASE -EA EMPLOYEE $500000 E.L. DISEASE -POLICY LIMIT I s5OO OOO DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: CRI# 2131070; Rigden Pump Station Earthwork; Work Order #CR-RWSR-2014-1 The City, its officers, agents and employees are named as additional insured, but only as respects liability arising out of work performed by the named insured. A waiver of subrogation applies. City of Fort Collins P.O. 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. ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #SB933131M892257 NIK Client#: 14427 CONREI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY) 05/27/2014 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 Endorsement(s). PRODUCER CONTACT NAME: Nikki MOsbrucker Flood 8 Peterson Ins., Inc. (PHONN En: g70 266-7123 we Np: 970 506-6823 P. O. Box 578 ADDRIESS: nmosbrucker@floodpeterson.com Greeley, CO 80632 INSURER(5)AFFOROING COVERAGE NAICp 970 356-0123 INSURER A: Travelers Insurance Company INSURED INSURER B:PInnacolAssurance Connell Resources, Inc. 7786 Highland Meadows Parkway #100 INSURER C: Fort Collins, CO 80528 INSURERD: 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. LTRR TYPE OF INSURANCE NSRL WVUB D POLICY NUMBER POLICY EFF POLICY MI0I DY/YYYV LIMITS A GENERALLIABILITY X COMMERCIAL GENERALLIABILITY CLAIMS -MADE 51 OCCUR X X DTC04794N532- IND14 111610112014 06101/201f EACH OCCURRENCE $1 000000 PAE`mA FEsT Ezoccu ante $300 000 MED EXP (Any one person) $10 000 PERSONAL 8 ADV INJURY S1,000,000 GENERAL AGGREGATE $2,000,000 t- AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMPIOP AGG $2,000,000 b A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS X X DT8104794N532- TIL14 6/01/2014 06/011201E COMBINED SINGLE LIMIT Ea accident EI,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident)$ X PROPERTY DAMAGE Per accident S $ A X UMBRELLA U AB EXCESS LUIB X OCCUR CLAIMS -MADE X X DTSMCUP4794N532- TIL14 Follows Form 111610112014 061011201E EACH OCCURRENCE $10 000 000 AGGREGATE $10 000 000 OED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA X 4019651 6/01/2014 01/011201 X WC- YLJM[-S I OTH- ER E.L. EACH ACCIDENT $500 000 E.L. DISEASE -EA EMPLOYEE s5000OO E. L. DISEASE -POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Re: CRI# 2141003 - Rigden Water Storage Reservoir Earthwork - WO# CR-RWSR-2014-2 Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. City of Fort Collins 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 ACORD 25 (2010/05) 1 of 1 #S893314IM892257 IS) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NIK Client#: 14427 CONREI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE7120I14 osnnzola 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 endomement(s). PRODUCER ACT NAME: Nikki Mosbrucker Flood & Peterson Ins., Inc. PHONE g70 266-7123 FAX(Ar970 506.6823 Eat: A/C No: P.O.Box578 EMAIL ADDRESS: nmosbrucker@floodpeterson.com Greeley, CO 80632 INSURER(S) AFFORDING COVERAGE NAIC it 970 356-0123 INsuRERA: Travelers Insurance Company INSURED INSURER B: Pinnacol Assurance Connell Resources, Inc. 7785 Highland Meadows Parkway 9100 INSURER C: Fort Collins, CO 80528 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 CONTRACTOR 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 ADOLSUBR INSR WVD POLICY NUMBER POLICY EFF MWDDffYYY) POLICY E%P (MMIDDrYYYYI LIMITS A GENERALLIABIDTY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX OCCUR X X DTC04794N532- IND14 6/01/2014 06101/2015 EACH $1000000 �OECCTURRENCE PREMISES Esowarence S300000 NEDEXP(Any ampersons $10000 PERSONAL S ADV INJURY $1000000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PER: FX PEOT 71 LOG PRODUCTS-COMPIOP AGG s2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON OMED AUTOS X X DT8104794N532- TIL14 6/01/2014 06/01I201 COMBINED SINGLE LIMIT Ea accitlem $1,000,000 BODILY INJURY (Per person) S IX BODILY INJURY (Per acdtlenQ $ PROPERTY DAMAGE Per accitlem S s A )( UMBRELLA UAB EXCESS LIAR X OCCUR CLAIMS -MADE X X DTSMCUP4794N532- TIL14 I Follows Form 061011201406101/201 EACH OCCURRENCE $10000000 AGGREGATE $10 000 000 DEO I J RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandate, In NH) DESCRIPTIONOFOPERATIONS below NIA X 4029651 6/01/2014 06101/2015 X WC STATU- DTH- E.L. EACH ACCIDENT $500 000 E.L. DISEASE - EA EMPLOYEEI E$00000 E.L. DISEASE -POLICY LIMIT 1 $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: CRI# 2141026 - College Avenue (US 287) Mulberry St to one block south of Pitkin St The City, its officers, agents and employees; and Colorado Department of Transportation are named as additional insured, but only as respects liability arising out of work performed by the named insured (Excluding Workers' Compensation). A waiver of subrogation applies. City of Fort Collins 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #SB93315/MB92257 NIK Client#: 14427 CONREI ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE(MwDDIYYYY) 05/27/2014 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 endomement(s). PRODUCER CONTACT Nikki Mosbrucker NAME: Flood 8. Peterson Ins., Inc. - PxoNE 970 266-7123 970 506-6823 AIC No Ex[ : A/C No P. O. Box 578 EMAIL ADDRESS: nmosbrucker@floodpeterson.com Greeley, CO 80632 970356-0123 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Travelers Insurance Company INSURED INSURERS: Pinnacol Assurance Connell Resources, Inc. 7785 Highland Meadows Parkway #100 INSURERC: Fort Collins, CO 80528 INSURERD: 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 CONTRACTOR 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 INSR MD I POLICY NUMBER POLICY EFF MMIDD POLICY EXP MWDDNYYY LIMITS A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CIAIMS.MADE 5XIOCCUR X X DTC04794N532- IND14 6/01/2014 06/0112011 EACH OCCURRENCE $1 000000 AMA ETORENTED REMI ES Eaoccurtence 8300000 MEDUP(My one demon) $10000 PERSONAL B ADV INJURY $1000000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JECTPRO LOC PRODUCTS - COMPIOP AGG s2000,000 E A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS WN HIRED AUTOS X NON-OED AUTOS X X DT8104794N532- TIL14 6/01/2014 06/01/2015 EOMaBBIINEDISINGLELIMIT $1,000,000 BODILY INJURY (Per person) S IX BODILY INJURY Pdent (Per acci ( I E PROPERTY DAMAGE$ Per accident A �( UMBRELLA LUIB EXCESS LIAB J( OCCUR CLAIMS -MADE X X DTSMCUP4794N532- TIL14 Follows Form 6/01/2014 06/01120115 EACH OCCURRENCE $10000000 AGGREGATE $10 000 000 QED I I RETENTIONS $ B WORKERS COMPENSATION ANDEMPLOYERS* LIABIUTY YIN ANY PROPRIETORJPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) Edescnbe under SCRIPTION OF OPERATIONS below NIA X 4029651 6/01/2014 06/01/201E X WCSTLAL DTH- E.L. EACH ACCIDENT $500000 E.L. DISEASE -EA EMPLOYEE $500 000 E. L. DISEASE -POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAttach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Contractors Right of Way License Certificate holder is named as additional insured, but only as respects liability arising out of work performed by the named insured (Excluding Workers' Compensation). City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Dept.; Attn: Lily ACCORDANCE WITH THE POLICY PROVISIONS. 281 North College Ave PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522-0580 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S893318/M892257 NIK Client#: 14427 CONREI ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATIYYYY) os/2n7/20nzola . 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 pollcy(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 endomement(s). PRODUCER CONTACT Nikki Mosbrucker NAME: Flood 8 Peterson Ins., Inc. °n"/c°"N :970 266-7123 AX T Na: 970 506-6823 P. 0.ee Box ADDRESS: nmosbrucker@floodpeterson.com Greeley, O 80632 970 356-0123 12 INSURER(S)AFFORDING COVERAGE NAICp INsuRERA: Travelers Insurance Company INSURED INSURER B: Plnnacol Assurance Connell Resources, Inc. 7785 Highland Meadows Parkway #100 INSURER C: Fort Collins, CO 80528 INSURERD: 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 ADDLSUBR' INSR WVD POUCY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD LIMITS A GENERALLMOILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR X X DTC04794N532- IND14 6/0112014 06101/2015 EACH 81000 QQQ p �OECCTURRENCE PREMISESEaowmrenm $300000 MED EXP (My one person) $10 000 PERSONAL& ADV INJURY $1000000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY X PRO- T LOC PRODUCTS - COMPIOP AGG $2,000,000 S A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS TOS AU HIREDAUTOS X NONOMNED AUTOS X X DT810479414532- TIL14 6/0112014 06/01/2015 COMBINED SINGLE LIMIT Ea acciderl $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY Peramdent E X PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE X X DTSMCUP4794N532- TIL14 Follows Form 6/01/2014 06101/2015 EACH OCCURRENCE $10000000 AGGREGATE $10000000 DED I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I NER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? IIf ves, deoryln NH)senbe and er DESCRIPTION OF OPERATIONS below NIA X 4029651 D610112014 06/01/201 X VVC STATU- OTH- E.L. EACH ACCIDENT $SOD QQQ E. L. DISEASE - EA EMPLOYEE $500000 EL DISEASE - POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, If more space Is required) RE: CRI# 2131065 - West Vine Outfall-Earthwork The City, its officers, agents and employees are named as additional insured, but only as respects liability arising out of work performed by the named insured. A waiver of subrogation applies. City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins Utilities ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 680 Fort Collins, CO 80622 I AUTHORIZED REPRESENTATIVE 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S8933191M892257 NIK Client#: 14427 CONREI ACORDn, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 0512712014 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 NAME: Nikki MOsbrucker Flood & Peterson Ins., Inc. PHONE 970 266-7123 Ax 970 506-6823 Ell:AIC No P. O. Box 578 E-M(RIAIL ADDRESS: nmosbrucker@floodpeterson.com Greeley, CO 80632 970 356-0123 INSURER(S) AFFORDING COVERAGE NAIL IN INsuRERA: Travelers Insurance Company INSURED INSURER B : Plnnacol Assurance Connell Resources, Inc. 7785 Highland Meadows Parkway #100 INSURER C:INSURER Fort Collins, CO 80528 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 CONTRACTOR 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 ADDL INSR SUB VND POLICY NUMBER POLICY EFF MwDD POLICY EXP MwDD LIMITS A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx� OCCUR X X DTC04794N532- IND14 6/01/2014 06101/201E EACH OCCURRENCE E1 OOD DDO RRVmAiJWSTEeeo uDnce E300000 MED EXP (Any one person) E 10 000 PERSONAL B ADV INJURY E1,000000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 17 POLICY X PRO- T LOC PRODUCTS - COMP/OP AGG E2,000,000 I E A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS X X DT8104794N532- TIL14 6/01/2014 06/011201E COMBINED SINGLE LIMIT Ea awdern $1,000,000 X BODILY INJURY (Per person) E P BODILY INJURY (Per a¢itlanl ( ) S X PROPERTY DAMAGE Per amdent E E A X UMBRELLA LIAB EXCESS LIAR j( OCCUR CLAIMS -MADE X X I DTSMCUP4794N532- TIL14 Follows Form 61011201406/011201 EACH OCCURRENCE E10000000 AGGREGATE $10 000 000 DED I RETENTIONS - E B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I NEB ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED' (Mandatory in NH) If yes, desad0e under DESCRIPTION OF OPERATIONS below NIA X 4029651 6/0112014 061011201E X VdC STATU- OTH- E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $500000 E1. DISEASE -POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, AEdidonal Remarks Schedule, if more space Is required) RE: Asphalt Supply Certificate holder is named as additional insured, but only as respects liability arising out of work performed by the named Insured (Excluding Workers' Compensation). A waiver of subrogation applies. City of Fort Collins Purchasing Division 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 ACORD 25 (2010/05) 1 of 1 #SB93320/M892257 V 1933-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 110 Client#: 14427 CONREI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE4YY) 05I2712017I2014 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 endomement(s). PRODUCER A NAME: Nikki Mosbrucker Flood 8 Peterson Ins., Inc. acD"ri Ex : 970 266-7123 FAX Nq 970 506-6823 P. 0.ee Box nmosbrucker@Floodpeterson.com COADDRIESS: Greeley, O 80632 970 356-0123 INSURER(S)AFFORDING COVERAGE NAICe INSURERA: Travelers Insurance Company INSURED INSURER B: Pinnacol Assurance Connell Resources, Inc. 7785 Highland Meadows Parkway #100 INSURER C: Fort Collins, CO 80528 NSURER D : INSURER E INSURER F : 14A9[yley-Al i4 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 CONTRACTOR 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. LTR TYPE OF INSURANCE ADDLSUBR INSR MD POLICY NUMBER POLICY EFF MwDO POLICY EXP MWDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL ABILITY CLAIMS -MADE OCCUR X X DTC04794N532- IND14 6/01/2014 06/0112016 EACH OCCURRENCE $1 000000 RREMmA sT Ez N.TE,`ence s300000 MEDEXP(Anyoneperson) $10000 PERSONALS ADV INJURY $1000,000 GENERALAGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOG PRODUCTS - COMPIOP AGG s2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIR ED AUTOS X NON-0WNED AUTOS X X DT8104794N532- TIL14 6/01/2014 0610112015 COMBINEDSINGLE LIMIT E... dent $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY Peraccident ( I S X PROPERTY DAMAGE Per acdtlenl $ $ A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE X X DTSMCUP4794N532- TIL14 Follows Form 6/011201406/011201 EACH OCCURRENCE $10000000 AGGREGATE $10000000 DED RETENTIONS I $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? 51 (Mandatory In NH) If yes desclll)e under DESCRIPTION OF OPERATIONS below NIA X 4029651 — 6101I2014 06/01/201 'X- i STATu-_ _ oTH= -_ E.L. EACH ACCIDENT $SOO$S5OO OOO E.L. DISEASE - EA EMPLOYEE DDO E.L. DISEASE - POLICY LIMIT 1 $500OOO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mare space Is required) RE: 7737 Asphalt Supply Services Agreement Certificate holder is named as additional insured, but only as respects liability arising out of work performed by the named insured (Excluding Workers' Compensation). A waiver of subrogation applies. City of Fort Collins Purchasing Division 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 ACORD 25 (2010105) 1 of 1 #S893321IM892257 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NIK Client#: 14427 CONREI ACORD. CERTIFICATE OF LIABILITY INSURANCE ORTE(MMIOD/YYYY) 06/27/2014 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 endorsement(s). PRODUCER "NAMEAC' Nikki Mosbrucker : Flood & Peterson Ins., Inc. PHONE 970 266-7123 970 506-6823 A/C No Ext : AIC No P. O. Box 578 E-MAIL ADDRESS: nmosbrucker@floodpeterson.com Greeley, CO 80632 970356A123 INSURER(S)AFFORDING COVERAGE NAICp INSURER A : Travelers Insurance Company INSURED INSURERS: Pinnacol Assurance Connell Resources, Inc. 7785 Highland Meadows Parkway #100 INSURERG: Fort Collins, CO 80528 INSURERD: 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 CONTRACTOR 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 INSR IWO POLICY NUMBER POLICY EFF MWDD/YYri POLICY EXP MWDDI LIMITS A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F7x OCCUR X X DTC04794N532- IND14 6/01/2014 06101/2011 $1000 000 pEACH�OCCURRENCE 1 a PRSIM ESEs0 ED..) s300000 MED EXP (Any one Person) $10 000 PERSONAL &ADV INJURY $1000000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PROJECT LOC PRODUCTS - COMPIOP AGG s2,000,000 S A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON-OMED AUTOS X X DT8104794N532• TIL14 6/01/2014 0610112015 COMBINED SINGLE LIMIT Ea accident $1,000,000 X BODILY INJURY (Per person) $ dent BODILY INJURY (Par acci) 8 X PROPmEdZDAMAGE Per auitlem $ S A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X X DTSMCUP4794N532- TIL14 Follows Form 6/01/2014 0610112015 EACH OCCURRENCE S10 000 000 AGGREGATE $10 000 000 DEO I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORRARTNERIEXECUTIVE OFFICEWMEMBER EXCLUDED' (Mandatory In NH) If yes, tlS�ePsauOMF eOPERAl10NGtdawx NIA X 4029651 6/0112014 061011201 X WC STATU- OTH- ER E.L. EACH ACCIDENT J$500,000 E.L. DISEASE -EA EMPLOYEE $500 000 E.L. DISEASE -POLICY LIMIT 1 $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, U mare space Is required) RE: CRI# 2121056 - Emergency Repair Mobilization Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. City of Fort Collins PO Box 680 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 ACORD 25 (2010105) 1 Of 1 #S8933161M892257 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NIK Client#: 14427 CONREI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MWODNYYY) 05/27/2014 . 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 INSURERIS), 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 endomement(s). PRODUCER NAME: Nikki Mosbrucker Flood 8 Peterson ins., Inc. PHONE 970 266.7123 A 970 506$823 AIC No Ell: AIC No: P. O. Box 578 E-MAIL nmosrucer ADDRESS: bk@floodeterson.com P Greeley, CO 80632 INSURER(S) AFFORDING COVERAGE NAIC0 970356-0123 INSURERA: Travelers Insurance Company INSURED INSURER B : Pinnacol Assurance Connell Resources, Inc. 7785 Highland Meadows Parkway #100 INSURER C: Fort Collins, CO 80528 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 ADDLSUBR INSR MD POLICY NUMBER POLICY EFF MM/DDI1'YYY POLICY EXP MMIDD/YYYY LIMITS • GENERAL LIABILITY X X DTC04794N532- D610112014 06101/2015 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx� OCCUR IND14 _ PREMISES E.EocTaErt°nce s3000OO MED EXP (Arty one person) $1 O 000 PERSONAL& ADV INJURY $1 000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO s2000,000 POLICY X PRO- LOC S A AUTOMOBILE LIABILITY X X DT8104794N532- 6/01/2014 06101/201 COMBINED SINGLE LIMIT Ea accident 8 1,000,000 X BODILY INJURY (Per Person) $ ANY AUTO TIL14 ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per acptlenl) S X PROPERTYDAMAGE Per accident s S A X UMBRELLA LU1B OCCUR X X DTSMCUP4794N532- 0610112014 0610112011 EACH OCCURRENCE $10 00O 000 N AGGREGATE S10000000 EXCESS LIAB CLAIMS -MADE TIL14 DEO RETENTIONS 1 1$ Follows Form B WORKERS COMPENSATION ANDEMPLOYERS'LIASIUTY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED' N/A X 4029651 0610112014 06/011201 X WCSTATU- OTH- ER E.L. EACH ACCIDENT $500 000 E.L. DISEASE - EA EMPLOYEE s5000OO (Mandatory in NH) '1yes, describe under DESCRIPTION OF OPERATIONS OeIaw E. L. DISEASE -POLICY LIMIT S600,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) RE: CRI# 2131066/ Aspen Heights - Fort Collins, CO Project Certificate holders are included as Additional Insured as required by written contract but only as respects liability arising out of work performed by the named insured. The coverage is primary and non-contributory to any other valid and/or collectible insurance to the fullest extent the law allows. Waiver of subrogation applies. Explosion, collapse, or undergroup property damage is included coverage. Certificate holder will be notified in writing 30 days prior to cancellation or material change. Fort Collins Urban Renewal Authority City of Fort Collins 300 Laporte Ave 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 ACORD 25 (2010105) 1 Of 1 #S8933371M892257 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NIK Client#: 14427 CONREI ACORD. CERTIFICATE OF LIABILITY INSURANCE OIYYM D06/2ATE 71O014 05/27/2014 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 endorsement(s). PRODUCER CONTACT Nikki Mosbrucker NAME: Flood 8 Peterson Ins., Inc. °w"c°NN Eau: 970 266-7123 FAX a,c, Ne; 970 506-6823 P. O. Box 578 E-MAIL nmosbrucker Nood eterson.com ADDRESS: @ P Greeley, CO 80632 970 356.0123 INSURER(S) AFFORDING COVERAGE NAIC0 INsuRERA: Travelers Insurance Company INSURED INSURERS: Plnnacol Assurance Connell Resources, Inc. 7785 Highland Meadows Parkway #100 INSURER C: Fort Collins, CO 80528 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 CONTRACTOR 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 ADDLSUBR INSR MD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR X X DTC04794N532- IND14 6/01/2014 06101/2015 EACH OCCURRENCE $1000000 PREMISES Ea mErenca $300000 MED EXP (Any one person) $10000 PERSONAL S ADV INJURY $1 000 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. POUCY X PRO- LOC JECT PRODUCTS - COMP/OP AGG $2,000000 E A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULEDBODILY AUTOS ATOHIRED AUTOS X NON-ONMED AUTOS X X DT8104794N532- TIL14 0610112014 06/01/201E COMBINED ISINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ALL IX INJURY (Per accident) $ PROPERTY DAMAGE Per accident S E A X[UMBR1LLA LIAB S LIAB X OCCUR CLAIMS -MADE X X DTSMCUP4794N532- TIL14 Follows Form 6/0112014 06/01/201 EACH OCCURRENCE $10000000 AGGREGATE $1000O 000 I RETENTION$ $ B WORKERS COMPENSATION ANDEMPLOYERS'LIABIDTY YIN ANY PROPRIETOR/PARTNERIEXECUTIVEN OFFICEWMEMBER EXCLUDED? (Mandatory In NH) It yes, desenbe under DESCRIPTION OF OPERATIONS llelmv NIA X 4029651 D610112014 06/01/201 )( we sTATu- OTH- E.L. EACH ACCIDENT $SOD OOO E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE - POLICY LIMIT s500 OOO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Ia required) RE: CRI# 2141026 - College Avenue Waterline Replacement Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. City of Fort Collins PO Box 580 Fort Collins, CO $0522 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 REPRESENTATNE ACORD 25 (2010105) 1 of 1 #S893310/M892257 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Client#: 14427 CONREI ACORD. CERTIFICATE OF LIABILITY INSURANCE °ATE 05/27/20147/2014 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 endorsement(s). PRODUCER CONTACTNikki Mosbrucker Flood 8. Peterson Ins., Inc. PNONE g70 266-7123 A 970 506.6823 AIC No Eat: AIC No: P. O. Box 578 E-MAIL ACOREss: nmosbrucker@floodpeterson.com Greeley, CO 80632 INSURER(S) AFFORDING COVERAGE NAIC# 970 356-0123 INsuRERA: Travelers Insurance Company INSURED INSURER B : Pinnacol Assurance Connell Resources, Inc. 7786 Highland Meadows Parkway #100 INSURER C: Fort Collins, CO 80528 INSURERD: 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 CONTRACTOR 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 AODLSUBR INSR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YY)Y LIMITS A GENERALUABIUTY XLOMMERCIALGENERALLIABILITV CLAIMS -MADE 51OCCUR X X DTC04794N532- IND14 6/01/2014 0610112016 EEACH OCCURRENCE $1 000000 PREMISESEiEoQnence s300000 MED EXP (Any one person) $10 000 PERSONAL S ADV INJURY $1000000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY X PRO- El LOG PRODUCTS - COMPIOP AGG s2,000,000 s A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS. ED HIREDAUTOS X NON-O AUTOS X X DT8104794N532- TIL14 6/01/2014 06101/2015 COMBINED SINGLE LIMIT Ea amdem a1,000,000 BODILY INJURY(Per person) S IX BODILY INJURY (Par acdItlent S PROPERTY DAMAGE Per awdent $ b A X1 UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X X DTSMCUP4794N532- TIL14 Follows Form 6/01/2014 06/0112015 EACH OCCURRENCE $10000000 AGGREGATE $10 000 000 DED I I RETENTIONS IS B WORKERS COMPENSATION ANDEMPLOYERS'l-MBILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, desarbe uWar DESCRIPTION OF OPERATIONS below N I A X 4029651 6/01/2014 06/01/2015 X I WCSTATU- OTH- ER E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE s500 000 E. L. DISEASE -POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remaras Schedule, If more apace is required) RE: CRI#2121036; BRT Phase 5 On -Call The City, its officers, agents and employees are named as additional insured, but only as respects liability arising out of work performed by the named insured. A waiver of subrogation applies. City of Fort Collins 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 ACORD 25 (2010105) 1 of I #S893311/M892257 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NIK