HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (59)AFRO®CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)06/03/2019
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 (g70) 266-7149 FAX (970) 506-6845
A/C No Ext : AIC, No):
PO Box 578
E-MAIL DStewart@floodpeterson.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA : Charter Oak Fire Insurance Company
25615
Greeley CO 80632
INSURED
INSURER B : Phoenix Insurance Company
25623
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 x6/2020 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 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
MMIDDYM^/Y
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE a OCCUR
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 LIMITAPPLIES PER.
GENERAL AGGREGATE
$ 2,000,000
POLICY JET7 LOC
PRODUCTS - COMP/OPAGG
$ 2,000,000
$
OTHER
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
Y
Y
DT-810-1 N000952-19-26-G
06/01/2019
06/01/2020
BODILY INJURY (Per accident)
$
X
PROPERTYDAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY HAUTOS ONLY
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 1,000,000
C
EXCESS LIAB
CLAIMS -MADE
Y
Y
CUP-8K942027-19-26
06/01/2019
06/01/2020
AGGREGATE
$ 1,000,000
DED I X1 RETENTION $ 10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICFR/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
Y
4029651
06f01/2019
06/01/2020
/� STATUTE 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
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: 2191036 - Sherwood Waterline (Laurel to Arthur Ditch)
Certificate holder is included as Additional Insured as required by written contract but only as respects to liability arising out of work performed by the named
insured. Waiver of subrogation applies.
CERTIFICATE 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.
P.O. Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522
/gym
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