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Home My WebLink About498970 HILL ENTERPRISES INC DBA HILL PETROLEUM - INSURANCE CERTIFICATE (6)/ ,® 4C CERTIFICATE OF LIABILITY INSURANCE DATEmrYI — �014 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 1st St SE CONTACT NAME: PHONE .319-366-2723 FAx .319-862-0612 UVC =LE .certs@truenorthcompanies.com Cedar Rapids IA 52401 INSURE S AFFORDING COVERAGE NAICO INSURER A:Nationwlde Agribusiness Insurance C 28223 INSURED HILLENT-01 Hill Enterprises, Inc 6301 Ralston Road INSURER B:Pinnacol Assurance Company 41190 INSURERC:Farmland Mutual Insurance Coma y 13838 INSURER D : Arvada CO 80002 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 14b04y:411Hy � THIS IS TO CERTIFY THAT THE POLICIES I W ON NUMBER: INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIUI REMENT, TERM OR CONDITION ANT CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEDD THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEENN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSO MD POLICY NUMBER POLICY EFF MMIDDl1^/YY POLICY EXP MMID LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR CPP1D4980A 1/1/2015 1/1/2016 EACH OCCURRENCE $1,000,000 AMA PREMISES Ea accunence $100,000 MED EXP(Any we parson) $5,000 PERSONAL S AM INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER. POLICY ❑ PERO- LOC GENERAL AGGREGATE $2,000.000 PRODUCTS - COMP/OPAGG $2,000,000 OTHER' E A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS MIRED AUTOS NON -OWNED AUTOS CPP104980A i/1/2015 1/1/2016 Eaac6NED E1,000,000 % BODILY INJURY (Per person) $ BODILY INJURY(Paramdent) $ PR Per acdtlanl $ $ A X UMBRELLA LJAB X OCCUR CU104980B /1/2015 1/1/2016 EACH OCCURRENCE E5.000,000 AGGREGATE $5,000,000 EXCESSLIAB CLAIMS -MADE DED X-1 REM NTIONbO $ B WORNERS COMPENSATION ANDEMPLOYERS'LNBILLTY YIN OFFICERIMEMBEREEXCWDEFp ECUTIVE ❑N NIA 4148287 /1/2014 /1/2015 X PER OTH- STATUTE ER E.L. EACH ACC, DENT $500,000 (Mandatory In NH) It yas, Oescrihe untlar DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE $500,000 E. L. DISEASE - POLICY LIMIT 1 $500,000 C Transportalion COP104980A /1/2015 1/1/2016 Limit 100,000 Deductible 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addidonel Nereanis SCWuW, may W attached "mom seem is rarlulmC) 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 under written contract with the above named insured. 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 Financial Services ACCORDANCE WITH THE POLICY PROVISIONS. AUTOO D REPRESENTATIVE 4 .'" ACORD CORPORATION All ninhie .vee. A ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD