The URL can be used to link to this page

Home My WebLink About498970 HILL ENTERPRISES INC DBA HILL PETROLEUM - INSURANCE CERTIFICATE (16)a DATE (MMIDD/YYYY) AC� L CERTIFICATE OF LIABILITY INSURANCE 6/30/2017 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER rrueNorth 500 1st St SE INSURED Hill Enterprises, Inc DBA Hill Petroleum 6301 Ralston Road Avada CO 80002 PH N (AlrNo t F.I. 720-491-5411 (cs �. E-MAIL , certs@truenorthcompanies.com ADDRESS INSURER(S) AFFORDING COVERAGE INSURER A: Nationwide Agribusiness Insurance INSURER n- Pinnacol Assurance ComDanv INSURER D : �roirnnrrc rrnTtnr ATr Ru uAorn. 11117F3d55 DFVICIrllv Pit IMRFD- 303-776-5495 NAIC i 28223 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 LT TYPE OF INSURANCE ODE�SMR INSD WVD. `_..__ POLICY NUMBER POLICY EFF MMJDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y CPP104980A 1/1/2017 1/1/2018 EACH OCCURRENCE _ $1,000,000 CLAIMS -MADE ❑X OCCUR DAMAGE TO REN I PREMISES Ea occurrence $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT ElLOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY Y COP104980A 1/1/2017 1/1/2018 COMBINED SINGLE 1WTT_ Ea accident $1,000,000 _ BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLA LIAB X OCCUR CU104980A 1/1/2017 1/1/2018 EACH OCCURRENCE $5,000,000 REXCESS AGGREGATE $5,000,000 LIAR CLAIMS -MADE DED x RETENTION$0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? NI (Mandatory in NH) N/A 4148287 6/1/2017 6/1/2018 H X STATUTE ER -- E.L. EACH ACCIDENT $1,000,000 $1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT If Ins, describe under DCRIPTION OF OPERATIONS below $1,000,000 A Transportation (Cargo) COP104980A 1/1/2017 1/1/2018 100,000 DESCRIPTION OF OPERATIONS I 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 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. CFRTIFICATF HOt_DER CANCELLATION City of Fort Collins Purchasing Department 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. AUTHOFZIZED REPRESENTATIVE 4%e0a,._ c0 1988-2015 AGURU GURI'URA I IUN. All rlgnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORO DATE (MM/DD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 6/29/2017 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 endorsements . PRODUCER CONTACT NAME__ _ TrueNorth PHE 720-491-5411 FAX 303-776-5495 500 1st St SE��o"�)WC_ certs@truenorthcomoanies.com INSURER A: Nationwide Agribusiness Insurance Company 28223 INSURED INSURER B:PInnacol Assurance Company 41190 Hill Enterprises, Inc INSURERC: DBA Hill Petroleum 6301 Ralston Road INSURERD: _ Avada CO 80002 INSURER E: f`(1\/FDA(:FC CCDTI17Ir1kTC KII IRADCO- 10527R7711 DCVICIMR1 R111MOCIM- 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 a INSD WVD . POLICY NUMBER POLICY EFF MM/DDlYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR CPP104980A 1/1/2017 1/1/2018 EACH OCCURRENCE $1,000,000 _IYAMAGE TiSRENTEIS— pREMISES (Ea occurrence $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO ❑ LOC JECT GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY COP104980A 1/1/2017 1/1/2018 COMBINED accident) $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ ERTYpAMAGE-- Pe_r_acckl nt) $ a A X UMBRELLA LIAB X OCCUR CU104980A 1/1/2017 1/1/2018 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DIED RETENTION $0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4148287 6/1/2017 6/1/2018 X I STATUTE I I FOR E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE '- $1,000,000 L. DISEASE - POLICY LIMIT I E1,000,000 A Transportation (Cargo) COP104980A 1/1/2017 1/1/2018 100,000 DESCRIPTION OF OPERATIONS / 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 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 Purchasing Department 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 4neo - C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD