HomeMy WebLinkAbout498970 HILL ENTERPRISES INC DBA HILL PETROLEUM - INSURANCE CERTIFICATE (10)AcoRD CERTIFICATE OF LIABILITY INSURANCE I uArp6/2W2/2020��1
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 ADDMONACINSURED; 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 COME: Stephanie Sloan, CIC
Flood and Peterson PHONEf.EU, (970) 356-0123 FAX (970) 330-1867
PO Box 578 E-MAIL
ADDRESS: SSloan@floodpeterson.com
INSURERS AFFORDING COVERAGE NAIL If
Greeley CO 80632 INSURER A; Philadelphia Insurance Companies 18058
INSURED INSURER 8: Pinnacol Assurance. 41190
Hill Enterprises Inc, DBA: Hill Petroleum INSURER C
63.01 Ralston Road INSURER 0:
INSURER E :
Arvada CO 80002 INSURER F:
nrni�nwr_cc reCTlelf`ATC Oil Rmiarm.1 20-21 0&MQInM u11MwFii•
THIS IS TO CERTIFY THATTHE 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.
LTA
TYPE OF INSURANCE
POLICY NUMBER.
u YEXP
MMO
UMnS-. _.. _...
_...
COMMERCIAL GENERAL IUUaLffY
.EACH OCCURRENCE. _
$. 1,000,000
rA
CLAIMS -MADE ® OCCUR
PREMISE Ea oe
$ 100,000
MED EXP(Any .one Person
$.0
706W/01/2020
PHPK2135616
06/01/2021
PERSONAL & ADV INJURY
$_1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE_
$, 2,000,000 _
PRODUCTS,-COMPIOPAGG
$. 21000,000
- POLICY ❑ JECTT LOC
$
OTHER:
AUTOMOBILE L ABILT,
COMBINED SINGLE LIMIT -
Ea accident
$-1,000,000
BODILY INJURY (Per Person) -
$ - -
ANY AUTO
A
OWNED. SCHEDULED
AUTOS ONLY AUTOS
HIRED - NON -OWNED
AUTOS ONLY AUTOS ONLY
I
PHPK2136615
06(01/2020
06/01/2021
BODILY INJURY(Par Occident)
$
PROPERTY DAMAGE -
Peraccidem
-$ --"- - - -
X
UMBRELLALJAB
OCCUR
I
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
-
$ 5,006,000
A
EXCESS LIAO
CLAIM MADE
PHUS723540
06/01/2020
06/01/2021
DED I X RETENTION $ 101000
$
1
-
B
WORKERS COMPENSATKIN
AND BrPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERIMEMBEREXCLUE
(Mandatory in NH)
NIA
4148287
O6/Ot/2020
O6/0112021
PER OTH-
STATUTE ER
- - - -
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 Os attached V more apace Is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of FOR Collins Purchasing Department
ACCORDANCE WITH THEPOLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO
80522
l91`J.ae-Zulu AWnu 6unrunAl jun. AH ngnX3 reserveO.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD