Loading...
HomeMy WebLinkAboutDRILLPRO SERVICES INC - INSURANCE CERTIFICATE (2)® ACC>Ri CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) OB/29/2018 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 NAME: CONTACT Peter Foley Moody Insurance Agency, Inc. acNN Ext : (303) 824-6600 Nc No): (303) 370-0118 8055 East Tufts Avenue E-MAIL peter. foley@moodyins.com ADDRESS: y INSURER(S) AFFORDING COVERAGE NAIC # Suite 1000 INSURERA: Cincinnati Indemnity Company 23280 Denver CO 80237 INSURED INSURER B : Pinnacol Assurance 41190 INSURER C : Homeland Ins Co of NY 34452 DrillPro Services, Inc. INSURER D : 2220 E 74th PI Unit A INSURER E : INSURER F : Thornton CO 80229 COVERAGES CERTIFICATE NUMBER: 18-19 Master 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DD/YYYY MMDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE Fx] OCCUR DAMAGE TO RENTEC5 PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 A Y EPP0208312 09/01/2018 09/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY JECT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS Y EPP0208312 09/01/2018 09/01/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED q NON -OWNED AUTOS ONLY AUTOS ONLY $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE EPP0208312 09/01/2018 09/01/2019 DED I X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 4023119 09/01/2018 09/01/2019 PER OTH- X STATUTE I ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 C Pollution Liability Y 7930002730006 09/01/2017 09/01/2018 Per Occurrence Aggregate $2,000,000 $2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as additional insured with respect to General and Automobile Liability as required by written contract, and Pollution Liability. 1,APII+CLLH 1 IVIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins Operations Services ACCORDANCE WITH THE POLICY PROVISIONS. 117 N Mason St AUTHORIZED REPRESENTATIVE Fort Collins CO 80521 / © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS General Liability Additonal insured status and Blanket Waiver of Subrogation to the extent provided in form GA 233 Automobile Liability Additional insured status to the extent provided in form AA 4171 Blanket Waiver of Subrogation to the extent provided in form AA 4172 Worker's Compensation Blanket Waiver of Subrogation as required by written contract. Pollution Liability Additional Insured Status to the extent provided in form OBENV GE 301 02 11 Primary and Noncontributory Coverage per form OBENV GE 319 02 11 Waiver of Subrogation per form OBENV GE 320 04 11 Contractors Equipment - Policy No EPP0208312 Scheduled Equipment Limit: $435,282 Leased/Rented Equipment Limit: $50,000 Deductible: $1000 IMPORTANT: Please note complete policy forms will NOT be mailed hard copy to certificate holders. To obtain full policy forms referenced herein, please provide our office with an email address or fax number for this and future certificate requests by sending an email to CertRequest@MoodyIns.com referencing both the Named Insured and Certificate Holder. I OFREMARK COPYRIGHT 2000, AMS SERVICES INC. I