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Home My WebLink About498970 HILL ENTERPRISES INC DBA HILL PETROLEUM - INSURANCE CERTIFICATE (12)ACO ® DATE (MM/DD/YYYY) �, CERTIFICATE OF LIABILITY INSURANCE 12/18/2015 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 certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME: True North Risk Mgmt TrueNorth PHONE FAX 500 1st St SE �JC,No 720-491-5411 303-776-5495 truenorthcom E-MAIL certs@truenorthcompanies.com Cedar Rapids IA 52401 °� p -ADDRESS- INSURER(S) AFFORDING COVERAGE NAIC S INSURER A: Nationwide Agribusiness Insurance C 28223 INSURED HILLENT-01 INSURERB:Pinnacol Assurance Company 41190 Hill Enterprises, Inc INSURER C: Farmland Mutual Insurance Company 13838 DBA Hill Petroleum 6301 Ralston Road INSURERD: Arvada CO 80002 INSURERE: COVERAGES CFRTIFICATF NIIMRFP- 172452096 R1:VIQIr1W IJI IMRFR• 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. I�TRR TYPE OF INSURANCE INSD WVI POLICY NUMBER POLICY EFF MM ICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CPP104980A 1/1/2016 1/1/2017 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $100,000 MED EXP (Any one person) $5,000 PERSONAL B ADV INJURY $1.000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY JEC7 7 LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY X� ANY AUTO CPP104980A 1/1/2016 1/1/2017 Ea accident $1,000,o00 BODILY INJURY (Per person) $ i ALL OWNEDSCHEDULED HIRED AUTOS NON -OWNED AUTOS $ $H --- BODILY INJURY (Per accident) AMA Per aocideM A X UMBRELLA LIAB X OCCUR CU104980B 1/1/2016 1/1/2017 EACH OCCURRENCE $5,000,000 AGGREGATE EXCESS LIAR CLAIMS -MADE $5,000,000 DED I X I RETENTION$0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N NIA 4148287 6/1/2015 6/1/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYE $500,000 (Mandatory in NH) yesdescnbe under E.L. DISEASE - POLICY LIMIT $500,000 !if DESCRIPTION OF OPERATIONS below C Transportation(Cargo) COP 104980A 1/1/2016 1/1/2017 Limit 100,000 Deductible 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS / 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. Additional insured and waiver of subrogation status is extended for work performed and required under written 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. A2ow- @