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Home My WebLink About498970 HILL ENTERPRISES INC DBA HILL PETROLEUM - INSURANCE CERTIFICATE (5)ACCN?o® CERTIFICATE OF LIABILITY INSURANCE li./ DAM(MMIDWYYYY) 12/31/2014 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 endorsements . PRODUCER TrueNorth 500 1 st St SE CONTACT NAME: 3AIPHONEN . 319-366-2723 FAC . 319-862-0612 =,,-certs@truenoFthcompanies.com Cedar Rapids IA 52401 INSURE S AFFORDING COVERAGE HAIG0 INSURER A: Nationwide Agribusiness Insurance C 28223 INSURED HILLENT-01 INSURERB:Pinnacol Assurance Company 41190 Hill Enterprises, Inc 6301 Ralston Road INSURERC:Farmland Mutual Insurance Company 13838 Arvada CO 80002 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 38202496 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 INSD VIVD POLICY NUMBER POLICY EFF M:&C/YEFF POt1CY ESP MMID LIMITS A x COMMERCIALGENERALUMILITY CLAIMS -MADE %OCCUR CPP104980A 1/1/2015 1/1/2016 EACH OCCURRENCE $1,000,000 MA ET R PREMISES Eacminerlce E700,000 MED EXP(My we Perron) $5,000 PERSONAL S ADV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY1:1 PET 0 LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ OTHER A AUTOMOBILELIABILITY /1/2015 /1/2016 Ea accident $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL rED SCHEDULED ALL S AUTOS HIRED AUTOS NON-OMEO AUTOS BODILY INJURY (Par accident) E PER A Per academ $ E A X UMBRELLA LIAR X OCCUR CU104980B 1/1/2015 1/1/2016 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000.000 EXCESS LIAR CLAIMS -MADE DIED I X I RETENTION$0 $ B WORKERS COMPENSATION AND EMPLOYERS' LABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED9 F N I A 148287 /1/2014 /1/2015 PER DTH- X STATUTE ER E.L. EACH ACCIDENT $500,000 E. L. DISEASE -EA EMPLOYE $500,000 (Mandatory In NH) f yyes, den,rbe Under EL. DISEASE -POLICY LIMIT $500,000 DESCRIPTIONOFOPERATIONS.1. C Transportation COP104980A 1/1/2015 1/1/2016 Limit 100,000 Deductible 5,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES IACORD 101, Additional Remain Schedule, may W attached If more space Is required) If Yes is indicated above for add'I insd forms Gen Liab #CGLB303 0413 and Auto #CA001 1013. If Yes is indicated above for waiver of subrogation forms Gen Liab #CGLB304 0310, Auto Liab #CCAB234 1013 and WC #WC000313 04/04 applies. Umbrella is following form per policy provisions, conditions and exclusions. Coverage is extended for work performed and required underwritten contract with the above 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. AUTOO D REPRESENTrATI``VE Mie �✓ ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD All rirhtx