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A J ('/ CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
05/28/2019
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
PHONE (970) 266-7149 FAx (970) 506-6845
A/C No Ext : AIC No
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
INSURER B : Phoenix Insurance Company
25623
INSURERC: Plnnacol Assurance
41190
Connell Resources, Inc.
INSURER D :
7785 Highland Meadows Parkway
INSURERE:
Suite 100
INSURER F :
Fort Collins CO 80528
rnVFRAr%FS rFRTIFICATE NUMRFR- GL/AU/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
ADDLSUBR
INSD
WVD
POLICY NUMBER
MMIODY/YYYY
MMIDDNYYY
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
DT-CO-4794N532-COF-19
06/01/2019
06/01/2020
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS-COMP/OPAGG
$ 2,OOQ000
POLICY PRO JECT ❑ LOC
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
XHIRED NON -OWNED
AUTOS ONLY X AUTOS ONLY
DT-81 0-1 N000952-19-26-G
06/01/2019
06/01/2020
80DILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PRO PRIR/PARTNER/E'ECUTIVE
OFFICER/MEMBMB ER EXCLUDED.
(Mandatory in NH)
NIA
4029651
06/01/2019
06/01/2020
PER OTH-
%� STATUTE ER
E.LEACHACCIDENT
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)
RE: CRI #2191011 Linden Street Bridge Riprap & Grout Project Certificate holder is included as Additional Insured as required by written contract with
respects to liability arising out of work performed by the named insured.
HULL)tK
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins Purchasing Division ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE r}--
Fort Collins CO 80522 (��tI
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ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD