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HomeMy WebLinkAboutSURE SHOT DRILLING INC - INSURANCE CERTIFICATE (3)AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) 3/1 /2017 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 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 Olson &Olson Ltd 5655 S Yosemite Street #200 Greenwood Village CO 80111 CONTACT NAME: AHONNo Ext :3 3-867-2 A/C No):303-867-2074 E-MAIL ADDRESS: 2 I onan I n. m INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Charter Oak Fire Ins Co 25615 INSURED SURES-2 INSURER B:Travelers Prop Cas Cof Amer 25674 INSURER C: In n Casualty Company 41483 Sure Shot Drilling, LLC Sure Shot Holdings, LLC 695 S Colorado Blvd. #440 INSURERD: Denver CO 80220 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 852007040 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 I TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMlDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY DTC05F464179COF17 3/2/2017 3/2/2018 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR DAMAGE T RENTED PREMISES Ea occurrence $300,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 O- POLICY X PRLOC $ B AUTOMOBILE LIABILITY DT8105F464179TIL17 3/2/2017 3/2/2018 Ea accident $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS q AUTOS B X UMBRELLA LIAR X OCCUR CUP2J2113911726 3/2/2017 3/2/2018 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 EXCESS LAB CLAIMS -MADE DED X RETENTION $10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ N / A DTFUB8G78986617 3/1/2017 3/1/2018 X I WC STATU- I OTH- TORY LIMITS E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder and those listed below (if any) are Additional Insureds as respects General Liability and Umbrella Liability on a Primary and Non -Contributory basis, and Auto Liability only if required by written contract or agreement and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions, and exclusions of the policy apply. The Worker's Compensation, General Liability, Auto Liability, and Umbrella Liability policies include a Waiver of Subrogation in favor of the Additional Insureds only if required by written contract or agreement. Contractor's License. L"arauaLh_ua City of Ft Collins PO Box 580 Fort Collins CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACOPD name and !egc are registered marks of ACORD