HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (40)ACOR,OCERTIFICATE OF LIABILITY INSURANCE
DATE //2019 Y)
05/28/28® 019
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
CONTACT Dana Stewart, CIC, CISR
NAME:
Flood and Peterson
AI/CONNo Ext : (970) 266-7149 AIC, No): (970) 506-6845
E-MAIL DStewart@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Charter Oak Fire Insurance Company
25615
Greeley CO 80632
INSURED
INSURERS: Phoenix Insurance Company
25623
INSURER C : Travelers Property Casualty Company of America
25674
Connell Resources, Inc.
INSURER D : Pinnacol Assurance
41190
7785 Highland Meadows Parkway
INSURERE:
Suite 100
INSURER F :
Fort Collins CO 80528
COVERAGES CERTIFICATE NUMBER: GL/AU/XS4/WC x6/2020 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
MMIDDY
MM/ DY EXP
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
PREMISES Ea occurrence
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
A
Y
DT-CO-4794N532-COF-19
06/01/2019
06/01/2020
G LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY � PECT RO ❑ LOC
J
PRODUCTS -COMPIOPAGG
$ 2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANYAUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED NON -OWNED
AUTOS ONLY /� AUTOS ONLY
Y
DT-810-1 N000952-19-26-G
06/01/2019
06/01/2020
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 4,000,000
C
EXCESSLIIAB
CLAIMS -MADE
Y
CUP-8K942027-19-26
06/01/2019
06/01/2020
AGGREGATE
$ 4,000,000
X DED RETENTION $ 10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
Y
4029651
06/01I2019
06/01/2020
/� STATUTE �RH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Project: 2191509 - Sherwood Waterline Replacement City of Fort Collins and Great Western are 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.
CERTIFICATE HOLDER GANGtLLAIIUN
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 CJw115�
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