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Home My WebLink AboutSURE SHOT DRILLING INC - INSURANCE CERTIFICATEACORO ® CERTIFICATE OF LIABILITY INSURANCE 10/31/2014 DATE(MMIDD/YYYY) 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 Olson & Olson Ltd 5655 S. Yosemite St. #101 Greenwood Village CO 80111 CONTACT NAME: AICO No EM:303 - 61 FAX No) :303-867- 7 E-MAIL ADDRESS :rhonda e h olsonandolso c INSURERS AFFORDING COVERAGE NAIC # INSURER A: INSURED SURES-1 INSURER B:Cha!ler Oak F re InsC0 25615 INSURERc:Travelers Prop Cas Cc of Amer Sure Shot Drilling, Inc. INSURER D:Pinnacol Assurance 41190 10188 WCR 23 Fort Lupton CO 80621 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 281262720 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 ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF IMMdDDNYYYI POLICY EXP fMWDDNYYYJLIMITS A GENERAL LIABILITY 4TCO99O7R375IND13 1/1/2014 1/l/2015 EACH OCCURRENCE S1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $300.000 CLAIMS -MADE F1 OCCUR MED EXP (Any one Perron) 510,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE S2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS COMP/OPAGG $2,000,000 $ POLICY X I PRO- LOD B LIABILITY BA9907R37513CNS 1/1/2014 1/1/2015 IMUINtU $1000000 BODI LY I NJURY(Per Perron) S ANY AUTO P040111LE ALL OWNEDSCHEDULED AUTOSAUTOSHIRED BODILY INJURY(Per acadent) $ PerOacaden DAMAGE S AUTOS X AON�OWNED $ C X UMBRELLA LIAB X OCCUR 4TSMCUP9907R375TIL13 11/1/2014 1/l/2015 EACH OCCURRENCE s4,000,000 AGGREGATE 54,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION S 10.000 1 S D WORKERS COMPENSATION 4024177 1/l/2014 1/1/2015 VV'C STATU- OTH- Y LIMIT OR AND EMPLOYERS' LIABILITY YIN ANY OFFICER/MEMBER IOEXCLUDR/E ECUTIVE � NIA EL. EACH ACCIDENT $1000D00 EL. DISEASE - EA EMPLOYE 81000000 (mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below EL.DISEASE -POLICY LIMIT :1000000 C Contract Equipment DT660367M4922TIL13 11/1/2014 1/1/2015 Equip Blanket Value $2,067,143 Deductible $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Certificate Holder and those listed below(if any) are Additional Insureds as respects General Liability and Umbrella Liability on a Primary and Non -Contributory basis, and Auto Liability only if required by written contract or agreement and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions, and exclusions of the policy apply. The Workers Compensation, General Liability, Auto Liability, and Umbrella Liability policies include a Waiver of Subrogation in favor of the Additional Insureds only if required by written contract or agreement. Contractors License. CERTIFICATE HOLDER CANCELLATION City of Ft Collins PO Box 580 Fort Collins CO 80522-0580 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 n 19RR-201n ACORn CORPORATION. All rinhts ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD