HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (51)ACCOR" CERTIFICATE OF LIABILITY INSURANCE
DATE Y)
05/2828//2019
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
PHONE (970) 266-7149 Fax (970) 506-6845
(PA No Ext : FAXNo):
E-MAIL DStewart@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S)AFFORDING COVERAGE
NAIC #
INSURERA: Charter Oak Fire Insurance Company
25615
Greeley CO 80632
INSURED
INSURER B : Phoenix Insurance Company
25623
Connell Resources, Inc.
INSURERC: Travelers Property Casualty Company ofAmerica
25674
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 x6/2020 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.
IICY
�TR
TYPE OF INSURANCE
IN
WVD
POLICY NUMBER
EFF
MMIDDYYYYY
EXP
MMLDDtYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
DT-CO-4794N532-COF-19
06/01/2019
06/01/2020
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTE
PREMISES Ea occurrence
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL &ADV INJURY
$ 1,000,000
GEN'LAGGREGATE LIMITAPPLIES PER:
POLICY PRO ❑ LOC
JECT
OTHER'
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS-COMP/OPAGG
$ 2,000,000
$
B
AUTOMOBILE LIABILITY
X ANYAUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
X AUTOS ONLY HAUTOS ONLY
DT-810-1 N000952-19-26-G
06/01/2019
06/01/2020
COMBINEDSINGLELIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
C
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
CUP-8K942027-19-26
06/01/2019
06/01/2020
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
DED I X RETENTION $ 10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
4029651
06/01/2019
06/01/2020
X PER STATUTE EORH
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: 2019 Asphalt Supply Certificate holder is named as additional insured, but only as respects liability arising out of work performed by the named insured
(Excluding Workers' Compensation) per written contract.
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 I (?�^
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