HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (74)ACORO®
��. CERTIFICATE OF LIABILITY INSURANCE
DATE (MMlDD/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
PHONE (970) 266-7149 FAX (970) 506-6845
A1C No Ext : AlC, No
E-MAIL DStewart@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIL #
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
SUHR
WVD
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MMIDDNYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE ® OCCUR
DAMAGE TO RENTE17-
PREMISES Ea occurrence
$ 300,000
MED EXP (Any one person)
g 10,000
PERSONAL BADVINJURY
S 11000,000
A
DT-CO-4794N532-COF-18
06/01/2018
06/01/2019
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
y 2.000,000
PRODUCTS-COMIOPAGG
2,000,000
S
POLICY❑JC O- F LOC
$
OTHER.E
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
S
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
11
DT-810-4794N532-IND-18
06/01/2018
06/01/2019
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 1.000,000
C
EXCESS LIAR
CLAIMS -MADE
CUP4J906749-18-26
06/01/2018
06/01/2019
AGGREGATE
S 1,000,000
DED I RETENTION $ 10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIRlPARTNERIE'ECUTIVE El
OFFICERlMEMBMBER EXCLUDED.
(Mandatory In NH)
N/A
Y
4029651
06/01i2018
06/01/2019
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
500,000
S
E.L. DISEASE - EA EMPLOYEE
S 500.000
E.L. DISEASE - POLICY LIMIT
S 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
I
I
I
DESCRIPTION OF OPERATIONS / LOCATIONS t VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
RE: 2181015 - City Misc. Improvements 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.
1 t MULUMM Ivry
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.
PO Box 580
AUTHORIZED REPRESENTATIVE y---
Fort Collins CO 80522 �,`uWutCl
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