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HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (66)AC ORo® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 05/31/2018 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 PHONE (970) 266-7149 FAX (970) 506-6845 A!C No Ext : AC,No): E-MAIL DStewart@floodpeterson.com ADDRESS: PO Box 578 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: 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 ADUL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXPLIMITS MM0D/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1.000,000 CLAIMS -MADE © OCCUR DAMAGE TO RF=N TEr5 PREMISES Ea occurrence S 300,000 MED EXP (Any one person) $ 10,000 A Y DT-CO-4794N532-COF-18 06/01/2018 06/01/2019 PERSONAL & ADV INJURY s 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE y 2,000,000 PRODUCTS -COMP7OPAGG $ 2,000,000 POLICY JE� LOC $ OTHER: AUTOMOBILE LIABILITY COaMaccdBINED SINGLE LIMITent iE $ 1,000,000 BODILY INJURY (Per person) S ANYAUTO BODILY INJURY (Pe raccident) s B OVyNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY DT-810-4794N532-IND-18 06/01/2018 06JO112019 PROPERTY DAMAGE Per accident $ $ Ll UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE S 1,000,000 C EXCESS LIAB CLAIMS -MADE CUP4J906749-18-26 06,101/2018 06/01/2019 DED I X RETENTION S 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY CERWEMB RlPARTNEREXECUTIVE � OFFlCERry In NH) EXCLUDED? (Mandatory In NH) N/A 4029651 06/01i2018 06/01/2019 PER OTH- STATUTE ER E.L. EACH ACCIDENT 500,000 $ E.L. DISEASE - EA EMPLOYEE 500,000 5 E.L. DISEASE - POLICY LIMIT 500,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 1.1, Additional Remarks Schedule, may be attached If more space Is required) RE: 2018 - COFC Asphalt Supply Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. Ii MIYV C�.L/1r 1VIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins, CO ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD