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HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (54)LCM. " A �..11l+JJJ/lam CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/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 A/CNNo Ext : (970) 266-7149 Fa/c No): (970) 506-6845 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 INSURERC: Travelers Property Casualty Company ofAmerica 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 x6/2020 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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. I LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDY/YYYYEFF POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR Z E1 PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 A Y Y DT-CO-4794N532-COF-19 06/01/2019 06/01/2020 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY I PRO ❑ LOC JECT $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 , BODILY INJURY (Per person) $ X ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY Y 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 $ 1,000,000 C EXCESSLIIAB CLAIMS -MADE CUP-8K942027-19-26 06/01/2019 06/01/2020 AGGREGATE $ 1,000,000 DIED RETENTION $ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA Y 4029651 06101/2019 06/01/2020 XSTATUTE EORH 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) CRI Job # 2181082- Spring Creek Stream Rehab Ph II 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. CFRTIFICATF HOLDER CANCELLATION 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 rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD