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Home My WebLink AboutDRILLPRO SERVICES INC - INSURANCE CERTIFICATE (5)AC4O061� b® CERTIFICATE OF LIABILITY INSURANCE FDATE(2MZo15 Y) 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Christine Walker, CISR,"CRIS NAME: Moody.Insurance Agency,- Inc. 8055 East Tufts Avenue aHcC . (303)824-6600 IAA F N,.OW370-0118 E-MAIL ADDRESS: christine.walker@mood1r ins.com Suite 1000 INSURERS AFFORDING COVERAGE NAIC# i INSURERA:Cincinnati Indemnity C2Lnpany 23280 Denver CO 80237 INSURED INSURER B:Pinnacol Assurance 41190 INSURER C: DrillPro Services, Inc. 2220 E 74th P1 Unit A INSURER D: INSURER E : Thornton CO 80229 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 No Forms RFVISION NIIMRFR- 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 LTR TYPE OF INSURANCE AD L INSO SUBRI WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 50, 000 MED EXP (Any one person) $ 10,000 X EPP0208312 9/1/2015 9/1/2016 PERSONAL &ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRO LOC POLICY JE GENERAL AGGREGATE $ 2, 000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COaBINED SINGLE LIMIT $ 1,060,000 X BODILY INJURY (Per person) $ A ANY AUTO ALL NED nSCHEDULED AUTOS AUTOSX X > EBA0208312 9/1/2015 9/1/2016 BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 0 $ EPP0208312 9/1/2015 9/1/2016 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes. describe under N/A 4023119 9/1/2015 9/1/2016 PER' OTH- X STATUTE ER E.L. EACH ACCIDENT $ 100.000 E.L. DISEASE- EA EMPLOYEE S 100,000 E.L. DISEASE - POLICY LIMIT E 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space is required) City of Fort Collins is included as additional insured with respect to General and Automobile Liability as required by written contract, and Pollution Liability. City of Fort Collins Operations Services 117 N Mason St Fort Collins, CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Walker, CISR, CRIS/� 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) ACORO® CERTIFICATE OF LIABILITY INSURANCE III9/2/2015 DATE(MWDDNYYY) 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: B 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Christine Walker, CISR, CRIS. NAME: Moody Insurance Agency, Inc. PHONo (303)824-6600 FA NC No: (303)370-0118 8055 East Tufts Avenue E-MAIL christine.walker@tttood ins.com ADDRESS: y - Suite 1000 INSURERS AFFORDING COVERAGE NAICIf INSURERA:Cincinnati Indemnity CoLnpany 23280 Denver CO 80237 INSURED INSURERB:Pinnacol Assurance 41190 INSURER C:Home land Insurance Co. of NY 34452 DrillPro Services, Inc. INSURER D: 2220 E 74th P1 Unit A INSURER E : Thornton CO 80229 INSURERF: COVERAGES CERTIFICATE NUMBER:15-16 w/Forms RFVISION NIIMRFn- 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 LTR I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person $ 10,000 X EPP0208312 9/1/2015 9/1/2016 PERSONAL &ADV INJURY $ 1,000,000 Additional Insured status GEN'L AGGREGATE LIMIT APPLIES PER: � PRO - POLICY LOC GENERAL AGGREGATE $ 2,000,000 applies only to the extent provided in form GA233CO PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: 05/11 , AUTOMOBILE LIABILITY Ee BINEccideU SINGLE LIMIT $ , 1,000,000 X BODILY INJURY (Per person) $ A. ANY AUTO ALL OS SCHEDULED AUTOS FI AUTOS X EBA0208312 9/1/2015 - 9/l/2016 BODILY INJURY Per accident ( ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 AI EXCESS LAB CLAIMS -MADE DED I X RETENTION$ 0 $ BHP0208312 9/1/2015 9/1/2016 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) es, describe under if DySCRIPTION OPERATIONS below DE N/A 4023119 9/1/2015 9/1/2016 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 100, 000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L.DISEASE-POLICY LIMIT 5 500,000 C Contractor's Pollution X 7930002730004 9/1/2015 9/1/2016 Limit $2,000,000 Deductible $5, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as additional insured with respect to General and Automobile Liability as required by written contract, and Pollution Liability. City of Fort Collins Operations Services 117 N Mason St Fort Collins, CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Walker, CISR, CRIS/� 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)