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Home My WebLink About579783 AMERICAN PIPELINE SERVICES - INSURANCE CERTIFICATEACORD- CERTIFICATE OF LIABILITY INSURANCE 10/1/2019 DATE(MMIDD/YYYY) 9/26/2018 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 have ADDITIONAL INSURED provisions or 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 Lockton Companies 8110 E. Union Avenue Suite 700 Denver CO 80237 ACT NAME: PHONE A/C No Ext : A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC a (303) 414-6000 INSURER A: The Travelers Indemnity Company 25658 INSURED American Pipeline Services 1343601 700 Billings Street, Unit L Aurora, CO 80011 INSURER B : The Charter Oak Fire Insurance Company 25615 INSURER C : Travelers Property Casualty Cc of America 25674 INSURER D : PmnaC01 ASSUiatlCe Company .41190 INSURER E: Greenwich Insurance Company 22322 INSURER F COVERAGES CERTIFICATE NUMBER: 14492336 REVISION NUMBER: XXXXXXX 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 ADDL iN D SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP (MM/DDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 1 D Ded.: $5-000 Y N DTC0326DO565 10/1/2018 10/1/2019 EACH OCCURRENCE $ 1,000,000 PREMISES (ETO a RENTED 300,000 X MED EXP (Ary oneperson) 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY JE � ❑ LOC OTHER. GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED 7-1 SCHEDULED AUTOS ONLY AUTOS RED � NON-OWNED ONLY AOS ONLY N Y N DT810326D0565 10/1/2018 10/1/2019 COMBINED SINGLE LIMIT Ea accident $ 1 000 000 X BODILY INJURY (Per person) $ XXXXXXX NJ ( BODILY INJURY Per accident $ XXXXXXX X PenAMAGEAUTOS eracadet $ XXXXXXX $XXXXXXX C UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE N N D7$MCUP326DO565 10/1/2018 10/1/2019 EACH OCCURRENCE $ 5 000MO X AGGREGATE $ 5,000,000 DED I X I RETENTION $ 10,000 $ XXXXXXX D WORKERS COMPENSATI AND EMPLOYERS' LABILIO Y Y/ N ANV PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N 4121983-CO 10/1/2018 10/1/2019 X STATUTE a R E L EACH ACCIDENT $ 1000 000 E L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE- POLICY LIMIT 1 000,000 E Pollution N N PECO02832608 110/1/2018 10/1/2019 Limit.$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Arthur Ditch -Canyon Avenue, Grout Joint Repair. The City of Fort Collins, its officers, agents and employees are listed as Additional Insured with respects to General Liability and Auto Liability if required by written contract. 30 day notice of cancellation is provided to certificate holder. CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14492336 AUTHORIZED REPRESENTATIVE The City of Fort Collins attn: Purchasing Department PC Box 580 Fort Collins CO 80522 ACORD 25 (2016/031 ©1 R812015 ACORD CORPOKATION. All riahts reserved The ACORD name and logo are registered marks of ACORD