HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (67)ACORC�® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM1DD/YYYY)
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
A CNNo Ext : (970) 266-7149 AIC, No : (970) 506-6845
E-MAIL DStewart@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIL k
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 60526
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 CONTRACTOR 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
ADDLSUBR
INSD
WVD
POLICY NUMBER
POLICY E F
MM/DDIYYYY
POLICY EXP
MMIDD/YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE ® OCCUR
DAMAGE TO RENT1717-
PREMISES Ea occurrence
$ 300,000
MED EXP (Any one person)
y 10,000
A
DT-CO-4794N532-COF-18
06,101/2018
06/01/2019
PERSONAL & ADV INJURY
$ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
$ 2.000,000
PRODUCTS-COMPIOPAGG
2,000,000
S
POLICY❑PRO
JECT❑LOC
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIN41T
.Ea accident
y 1,000,000
BODILY INJURY (Per person)
s
ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
DT-810-4794N532-IND-18
06/01/2018
06/01/2019
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
Per accident
S
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
S 1.000,000
C
EXCESS LIAB
CLAIMS -MADE
CUP4J906749-18-26
06/01/2018
06/01/2019
AGGREGATE
$ 1,000,000
DED I X RETENTION S 10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y 1 N
ANY PROPRIETOFUPARTNERrEXECUTIVE
OFFICERiMEMBER EXCLUDED?
(Mandatory In NH)
NIA
Y
4029651
06/01i2018
06/01/2019
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
E.L. DISEASE - POLICY LIMIT
500,000
S
If yes. describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
CRI Job # 2181011 - BUCKINGHAM AND LEMAY WATER MAIN REPLACEMENT Certificate holder is included as Additional Insured as required by written
contract but only as respects to liability arising out of work performed by the named insured. Waiver of subrogation applies.
CEKTIFICAI E FIULUEK
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 ��dGC7u+uU1
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