HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (64)ACOR" CERTIFICATE OF LIABILITY INSURANCE
�.-
DATE 05/31/31//2018 )
018
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 endorsement(s).
PRODUCER
CONTACT Dana Stewart, CIC, CISR
NAME:
Flood and Peterson
AIC No. Ext : (970) 266-7149 �C. No : (970) 506-6845
PO Box 578
E-MAIL DStewart@floodpeterson.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIL #
INSURERA: Charter Oak Fire Insurance Company
25615
Greeley CO 80632
INSURED
INSURER B : Travelers Indemnity Company
25658
Connell Resources, Inc.
INSURER c : Travelers Property Casualty Company of America
25674
7785 Highland Meadows Parkway
INSURER D : Pinnacol Assurance
41190
INSURER E :
Suite 100
INSURER F :
Fort Collins CO 80528
COVERAGES CERTIFICATE NUMBER: GL/AU/XS/WC x6/2019 REVISION NUMBER:
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
AUUL51J5K
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DO
POLICY EXP
MM/DD/YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE ® OCCUR
DAMAGE TO p
PREMISES Ea occurrence
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
A
DT-CO-4794N532-COF-18
06/01/2018
06/01/2019
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY JECT LOC
PRODUCTS - COMP!OP AGG
S 2,000,000
S
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
C Ea accdent
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
DT-810-4794N532-IND-18
06/01/2018
06/01/2019
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
5
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
5 1,000,000
AGGREGATE
$ 1,000,000
C
EXCESS LIAB
CLAIMS -MADE
CUP4J906749-18-26
06/01/2018
06101/2019
X DED RETENTION $ 10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIPARTNERrEXECUTIVE
OFFICEW'MEMBER MBER EXCLUDED?
(Mandatory In NH)
NIA
4029651
06/01/2018
06/01/2019
PER OTH-
STAT UTE I I ER
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
S 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
5 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
CRI Job # 2181009 - Dry Creek Box Culvert Certificate holder is included as Additional Insured on General liability and Automobile liability as required by
written contract with respects to liability arising out of work performed by the named insured.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
700 Wood Street
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522
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