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HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (73)ACOR I , CERTIFICATE OF LIABILITY INSURANCE DATE (MMtDDIYYYY) 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 HONE Ezt . (970) 266-7149 aC, No): (970) 506-6845 E-MAIL DStewart@floodpeterson.com ADDRESS: PO Box 578 INSURER(S) AFFORDING COVERAGE NAIC # 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 CnVFRACFS 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 EFF MM/DD/YYYY POLICY EXP MMlDDfYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ® OCCUR DAMAGE TO RENTE7- PREMISES Ea occurrence $ 300.000 MED EXP (Any one person) $ 10,000 A DT-CO-4794N532-COF-18 06/01/2018 06/01/2019 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 PRODUCTS-COMP!OPAGG $ 2,000,000 POLICY ❑ PEA ❑ LOC S OTHER: AUTOMOBILE LIABILITY COEMBINED SINGLE LIMIT a accident g 1,000,000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY DT-810-4794N532-IND-18 06/01/2018 06101/2019 PROPERTY DAMAGE Per accident S $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1.000,000 C EXCESS LIAB CLAIMS -MADE CUP4J906749-18-26 06/01/2018 06/01/2019 AGGREGATE $ 1,000,000 DIED I X RETENTION $ 10,000 S D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y r N ANY PROPRIETOFL'PARTNERtE,XECUTIVE EylNIA OFFICERiMEMBER EXCLUDED (Mandatory In NH) Y 4029651 06/01/2018 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 5 If Ves, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS f LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) 2161070 - DWRF Engineer Field Office Driveway Grading 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. [d�;illl;yL�� 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. 215 N. Mason Street AUTHORIZED REPRESENTATIVE Box Fort Fort Collinsns CO 80522 © 1988-2015 ACORD CORPORATION. All rights reservea. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD