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Home My WebLink AboutSURE SHOT DRILLING - INSURANCE CERTIFICATEI'?LMNI2 NIN2 2 �`-.� DATE (MMIDDNYYY) L• CERTIFICATE OF LIABILITY INSURANCE 03/01/2019 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 1-303-534-4567 CONTACT NAME: INA, Inc. - Colorado Division PHONE AX EC,LLNo-Sift- — -- (A/C. NO6— ----- --- 1705 17th Street ADDRESS: DsnAccountTecho@imacorp.com Suite 100 INSURER(S) AFFORDING COVERAGE NAIL• Denver, CO 80202 INSURER A: VALLEY FORGE INS CO(CNA insurance) 20509 INSURED INSURERS: COWIi8lNTAL INS CO(CNA Insurance) 35289 Sure Shot Drilling INSURERC: PIMIRCOL ASSUR 41190 5355 Dahlia St. INSURERD: INSURER E : Coerce City, CO 80022 INSURERF rnVFRerFC rFRTIFIrATF NIIMRFR• 55519577 RFVISInN NLIMRFR- 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 CONTRACT OR 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. TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIAMLITY 6076512416 03/01/19 03/01/20 EACH OCCURRENCE : 1,000,000 CLAIMS -MADE tJ OCCUR DAMAGE TOENTED PREMISEE oaanence 6 500,000 MED EXP (Any one parson) $ 15,000 PERSONAL S ADV INJURY $ 1,000,000 GENII AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY a JJC LOC PRODUCTS - comp/op AGG $ 2,000,000 $ OTHER. B AUTOMOEWELIAPILITY 6076512383 03/01/19 03/01/20 C BIN DDSINGLELIMIT Its scodenl $ 1,000,000 BODILY INJURY (Per person) f ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOSHIRED N BODILYINJURY(PeracddmQ f PROPERTYDAMAGE Per acciden f X NON -OWNED AUTOS ONLY AUTOS ONLY f B X UMBRELLALUIB X OCCUR 6076512366 03/01/19 03/01/20 EACH OCCURRENCE 6 4,000,000 AGGREGATE $ 4,000,000 EXCESS LMA CLAIMS -MADE DED f X RETENTION= 10,000 : C WORKERS COMPENSATION AND EMPLOYERS' LIABILnY YIN ANYPROPRIETORIPARTNER-XECUTIVE a OFFICER/MEMBEREXCLUDED? (Mandatory In NH) NIA 4215483 03/01/19 03/01/20 X STATUTE EORH ---- -- E.L. EACH ACCIDENT f 1,000,000 _-- E.L. DISEASE - EA EMPLOYEE S 1,000,000 E.L. DISEASE -POLICY LT $ 1,000,000 tf yea dasatbe uLIMITnder DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddtOonal Remarks Schedule, may be alrachsd If more space Is rpulmd) City of Ft Collins is included as Additional Insured on the General, Automobile, and Umbrella Liability Policies if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Additional Insured on the General, Automobile, Umbrella Liability and Workers Compensation Policies if required by written contract or agreement and with respect to work performed by Insured subject to the policy terns and conditions. This Insurance is Primary and Non -Contributory on the General, Automobile and Umbrella Liability Policies subject to the policy terms and conditions. GEKIII-IGAIt HVLUtK GANGtLLAIIVN rcityco—f tractor's License. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ft Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BOX 580 t Collins, CO 80522-0580 ACORD 25 (2016/03) francine 55519577 AUTHORIZED REPRESENTATIVE //,J USA / /,# 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD O N