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HomeMy WebLinkAbout498970 HILL ENTERPRISES INC DBA HILL PETROLEUM - INSURANCE CERTIFICATE (14)ACORO® CERTIFICATE OF LIABILITY INSURANCE 712/22/2017 E (MM/DD YYV� 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 NAME: _ TrueNorth PHONE FAX 500 1 st St SE - No Ext : 720-491-5411 A/c No): 303-776-5495 INSURED Hill Enterprises, Inc DBA Hill Petroleum 6301 Ralston Road Avada CO 80002 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Plnnacol Assurance Company 41190 INSURER B: Philadelphia Indemnity Insurance Company 18058 INSURER C : E: rnVFRAGFS CFRTIFICATF Nl IMRFR• 9ndgRRng7B RFVISION 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 DDL S BR POLICY NUMBER MM DD/YYYF MM/DD/Yl'Y—T —POLICY P LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR Y PHPK1753505 1/1/2018 6/1/2019 EACH OCCURRENCE $ 1,000.000 PREMISES Ea occurrence $100,000 MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY [ ] PRO- ❑ LOC JECT OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 _ $ B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY Y PHPK1753505 11112018 6/1/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE APer accident $ S B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PKJB611491 1/1/2018 6/1/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE IN OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under li DESCRIPTION OF OPERATIONS below N / A 4148287 6/1/2017 6/1/2018 XER OTH- STATUTE ER $1,000,000 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ 1,000,000 _ $ 1.000,000 E.L. DISEASE - POLICY LIMIT B Transportaton(Cargo) PHPK1753505 1/1/2018 6/1/2019 100.000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) If Yes is indicated above for add'I insd forms Gen Liab #CG2026 and Auto #PI FDL 008. If Yes is indicated above for waiver of subrogation forms Gen Liab #PI GLD FDL, Auto Liab #PI FDL 001 and WC #WC000313 04/04 applies. Auto policy includes broadened coverage for pollution endorsement CA9948 1013. Umbrella is following form per policy provisions, conditions and exclusions and does apply to the employers liability. Additional insured and waiver of subrogation status is extended for work performed and required under written contract with the above named insured. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Financial Services, Purchasing Division 215 N Mason St 2nd Floor PO Box 580 Fart Collins CO 80522 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD