HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (75)A ^ (J^R Q®
l`✓'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
AIC No. Ext : A/C, No):
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
rnVFRArFS CERTIFICATE NUMBER- GUAU/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
ADDLSUBR
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MMIDDIYYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1.000,000
CLAIMS -MADE ® OCCUR
DAMAGE TO RENI F77
PREMISES Ea occurrence
$ 300,000
h1ED EXP (Any one person)
$ 10,000
A
Y
DT-CO-4794N532-COF-I8
06/01/2018
06/01/2019
PERSONAL& ADV INJURY
S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
S 2,000,000
PRODUCTS - COMP?OPAGG
2,000,000
$
POLICY ❑ PRO- ❑
JECT LOC
$
OTHER:
AUTOMOBILE LIABILITY
C061BINED SINGLE LIMIT
'Ea a.'d.nt
g 1,000,000
BODILY INJURY (Per person)
S
ANY AUTO
BODILY INJURY (Per accident)
$
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
H
Y
DT-810-4794N532-IND- 18
06/01/2018
06/01/2019
PROPERTY DAMAGE
Per accident
$
$
1
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 1.000,000
C
EXCESS LIAB
HCLAIMS-MADE
Y
CUP4J906749-18-26
06/01/2018
06/01/2019
AGGREGATE
$ 1,000,000
DED RETENTION $ 10'000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY v I N
ANY CERWETOFL'PARTNERIEXECUTIL'E
OFFICERiMEMBER EXCLUDED?El
(Mandatory In NH)
NIA
Y
4029651
06/01/2018
06/01/2019
PER OTH-
STATUTE ER
E. L. EACH ACCIDENT
$ $00,000
E.L. DISEASE - EA EMPLOYEE
$ 500.000
E.L. DISEASE -POLICY LIMIT
$ 500,000
If ves, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
RE: 8310 Aggregate Supply Certificate holder is named as additional insured, but only as respects liability arising out of work performed by the named
insured (Excluding Workers' Compensation). A waiver of subrogation applies.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins Purchasing Division ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522 I 1
U 1988-Zo19 A[:UKU t;UKI'UKAI IUN. All rlgnts reservea.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD