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HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (35)ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (M 10/23//2018 Y) 018 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 NTA T Dana Stewart, CIC, CISR NAME: Flood and Peterson o Ext : (870) 266-7149 PHONE FAX A/C No,No): (970) 506-6845 PO Box 578 E-MAIL DStewart@floodpeterson.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Greeley CO 80632 INSURER A : Charter Oak Fire Insurance Company 25615 INSURED INSURER B : Travelers Indemnity Company 25658 INSURER C : Travelers Property Casualty Company of America 25674 Connell Resources, Inc. INSURER D : Pinnacol Assurance 41190 7785 Highland Meadows Parkway INSURER E : Suite 100 INSURER F : Fort Collins CO 80528 COVERAGES CERTIFICATE NUMBER: GL/AU/XS/WC x6/2019 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 WVD POLICY NUMBER POLICY / MM/DDIYYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 CLAIMS -MADE OCCUR 17 PREMISES Eaoccurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 A Y DT-CO-4794N532-COF-18 06/01/2018 06/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2.000,000 POLICY � PET LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000.000 BODILY INJURY (Per person) S X ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS Y DT-810-4794N532-IND-18 06/01/2018 06/01/2019 BODILY INJURY (Per accident) S PROPERTY DAMAGE Peraccident $ HIRED NON -OWNED X AUTOS ONLY IX AUTOS ONLY $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 C EXCESS LIAR CLAIMS -MADE Y CUP4J906749-18-26 06/01/2018 06/01/2019 DED X RETENTION $ 10,000 $ D wORK 5 COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 4029651 06/01/2018 06/01/2019 X PER OTH- STATUTE ER EL EACH ACCIDENT 500,000 $ E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT 500,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: 2181076 - Pineridge Trail Maintenance City of Fort Collins is included as Additional Insured on General liability and Automobile liability as required by written contract with respects to liability arising out of work performed by the named insured. %,AIYI.CLLA I IUIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522� © 1988-2015 ACORD CORPORATION. All rlgnts reservea. ACORD 25 (2016103) The ACOP.D name and logo are registered marks of ACORD