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��. CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
03/11/2019
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 Brianne Danielson, CISR
NAME:
Flood and Peterson
PHONE (g70) 266-7118 FA% (970) 506-6846
A/C No Ext : FAXNo):
Corporate Mailing Address:
E-MAIL BDanielson@FloodPeterson.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC 8
P.O. Box 578
INSURERA: Union Insurance Company
25844
Greeley CO 80632
INSURED
INSURER B : Pinnacol Assurance
41190
INSURER C :
Energy Services of Colorado, Inc.
INSURER D :
dba ESCO
INSURER E :
960 W. 124th Avenue, Suite 900
INSURER F :
Westminster CO 80234
COVERAGES CERTIFICATE NUMBER: CL1931128054 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 MAY BE 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.
INSR
LTR
TYPE OF INSURANCE
AIJIULbUdil
INSD
WVD
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MM/DDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE FX1 OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
300,000
$
X
MED EXP (Any one person)
$ 10,000
$500 Deductible - Property
Damage
PERSONAL & ADV INJURY
$ 1,000,000
A
Y
CPA316081422
03/15/2019
03/15/2020
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRO-
POLICY PRO ❑ LOC
JECT
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANYAUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
Y
CPA316081422
03/15/2019
03/15/2020
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Per accident
$
HIRED HNON-OWNED
AUTOS ONLY AUTOS ONLY
Medical Payments
$ 5,000
X
UMBRELLA LIAR
X
OCCUR
EACH OCCURRENCE
$ 6,000,000
AGGREGATE
$ 6,000,000
A
EXCESS LIAR
CLAIMS -MADE
CPA316081422
03/15/2019
03/15/2020
DED I X1 RETENTION $ 0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE �
OFFICERIMEMBER EXCLUDED.
(Mandatory in NH)
N/A
4079460
04/01/2019
04/01/2020
X PR SEATUTE EORH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
A
Leased / Rented Equipment
CPA316081422
03l15/2019
03/15/2020
Limit
$250,000
Deductible
$1,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
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.
ULK I IFIGAI t HULUCK
City of Fort Collins - Purchasing Department
215 N. Mason, 2nd Floor
P.O. Box 580
Fort Collins
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
I AUTHORIZED REPRESENTATIVE
CO 80522 Vita, lat anie&o u.
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD