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HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (57)l ® ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 05/16/2019 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 AIC No Ext : AIC No E-MAIL DStewart@floodpeterson.com ADDRESS: PO Box 578 INSURERS) AFFORDING COVERAGE NAIC p INSURERA: Charter Oak Fire Insurance Company 25615 Greeley CO 80632 INSURED INSURER B : Travelers Indemnity Company 25658 INSURER C : 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 x6/2019 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 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 Y MMIDDIYYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE300,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,000 PERSONAL 8ADVINJURY $ 1,000,000 A Y DT-CO-4794N532-COF-18 06/01/2018 06/01/2019 GEN'LAGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $ 2,000,000 POLICY � ECT LOC PRODUCTS - COMP/OPAGG $ 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 Y DT-810-4794N532-IND-18 06/01/2018 06/01/2019 BODILY INJURY (Pe raccident) $ PROPERTY DAMAGE Per accident $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 C EXCESS LIAB CLAIMS -MADE Y CUP-8K942027-18-26 06/01/2018 06/01/2019 DED I X1 RETENTION $ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N/A 4029651 06/01/2018 06/01/2019 X STATUTE EORH E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 500,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: 2191026 - Willow Street Improvements (W02) 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. GtKI IHL;AI t NULII 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 REPRESENTATIVEpy�----;t'— Fort Collins CO 80522 ytifwll��COA1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD