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HomeMy WebLinkAbout498970 HILL ENTERPRISES INC DBA HILL PETROLEUM - INSURANCE CERTIFICATE (11),ac Ro® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1 5/18/2015 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 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 PRODUCER FrueNorth M 1st St SE cedar Rapids IA 52401 INSURED Hill Enterprises, Inc 6301 Ralston Road Arvada CO 80002 iAcc° I. ,. 319-366-2723 FAX No). 319-862-0612 E-MAIL certs@truenorthcompanies.com -- Annacce _ INSURER A: Nationwide Agribusiness Insurance C HILLENT-01 INSURERB:Farmland Mutual Insurance Company INSURER C:Pinnacol Assurance Company INSURER D : INSURER E rnVF'RA(_FR r`CATICI( ATC III IMQCD• 1513i Qini1 Mc 1-- u. u 13838 41190 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. INSR I ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR CPP104980A 1/1/2015 1/1/2016 EACH OCCURRENCE $1,000,000 DAMkFE RENTED PREMISES Ea occurrence $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT ❑ LOC GENERAL AGGREGATE $2,000,000 GEN'L PRODUCTS - COMP/OP AGG $2,000,000 OTHER I$ A AUTOMOBILE LIABILITY CPP104980A 1/1/2015 1/1/2016 COMBINED1 $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL AUTOS SCHEDULED BODILY INJURY (Per accident) ZER $ HIRED AUTOS NON -OWNED AUTOS R PY AMA Per accident $ $ A X UMBRELLA I B X OCCUR CU104980B 1/1/2015 1/1/2016 EACH OCCURRENCE $5,000,000 EXCESS uAe CLAIMS -MADE AGGREGATE $5,000,000 DED I X RETENTION $0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N NIA 4148287 /1/2015 /1/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYE $500,000 (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $500,000 B Transportation COP104980A /1/2015 1/1/2016 Limit 100,000 Deductible 5,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) If Yes is indicated above for add'I insd forms Gen Liab #CGLB303 0413 and Auto #CCAB191 1013. If Yes is indicated above for waiver of subrogation forms Gen Liab #CGLB304 0310, Auto Liab #CCAB191 1013 and WC #WC000313 04/04 applies. Auto policy includes broadened coverage for pollution endorsement CA9948 1013. Umbrella is following form per policy provisions, conditions and exclusions and does not apply to the employers liability. Coverage is extended for work performed and required underwritten contract with the above named insured. CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO Box 580 Fort Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHO IZED REPRESENTATIVE 'Iow - © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD