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HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (58)A�Ro® CERTIFICATE OF LIABILITY INSURANCE DATE(MY) O5/28//0192019 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 FAX A/CONNo, Ext : (970) 266-7149 A/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 rnVFRAC;FS 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 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. I LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER EFF MM/DDY/YYYY EXP MM/DDYIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR PREMISES Ea occunence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 A DT-CO-4794N532-COF-19 06/01/2019 06/01/2020 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY JECT PRO ❑ LOC $ 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 DT-81 0-1 N000952-19-26-G 06/01/2019 06/01/2020 BODILY INJURY (Per accident) s 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 X DED RETENTION $ 10,000F $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory In NH) NIA 4029651 06/01/2019 06/01/2020 %� STATUTE EERPER H 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 # 2181009 - Dry Creek Box Culvert Certificate holder 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. rFRTIFIrATF Hf11 r1FR 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. 700 Wood Street AUTHORIZED REPRESENTATIVE FortCollins CO 80522����U ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD