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Home My WebLink About498970 HILL ENTERPRISES INC DBA HILL PETROLEUM - INSURANCE CERTIFICATE (15)Act CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDfYYYY) 12/22/2017 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 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 A/C No Ext : 720-491-5411 A/c No): 303-776-5495 INSURER(S) AFFORDING COVERAGE NAIC k INSURER A: Pinnacol Assurance Company 41190 INSURED INSURER B: Philadelphia Indemnity Insurance Company 18058 Hill Enterprises, Inc DBA Hill Petroleum INSURERC: 6301 Ralston Road INSURER D: Avada CO 80002 INSURER E : r nVFRAr;FS CFRTIFICATF NIIMRFP-Rg94R173F RF\/I51(7N 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. ILT R LTR TYPE OF INSURANCE DDL R POLICY NUMBER POLICY EFF MM/DD/YYYPOLICY P LIMITS B X COMMERCIAL GENERAL LIABILITY Y PHPK1753505 1/1/2018 6/1/2019 EACH OCCURRENCE $1,000,000 CLAIMS -MADE a OCCUR — $ 100,000 TOM - TO MTE PREMISES Ea occurrence MED EXP (Any one person) $0 PERSONAL & ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICYnPRO- L . _J JECT LOC $2,000,000 PRODUCTS •COMP/OP AGG OTHER: $ B AUTOMOBILE LIABILITY Y PHPK1753505 1/1/2018 8/1/2019 COMBINED S NGLE LIMIT Ea accident = 1 000000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY _ s B X UMBRELLA LIAB X OCCUR PHUB611491 1/1/2018 6/1/2019 EACH OCCURRENCE $5,000,000 17 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNER/EXECUTIVE N 4148287 8/1/2017 6/1/2018 OTH- X STATUTE ER E.L. EACH ACCIDENT $1.000,000 OFFICER/MEMBE R EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1A00,000 B Transportation(Cargo) PHPK1753505 1/1/2018 11/112019 10D,000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 GILD 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. ULR I IFIUA I L HOLUtR UANUtLLA I IUN City of Fort Collins Purchasing Department PO Box 580 Fort 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. AUTOO IZED REPRESENTATIVE 4%eoa,- C 1988-2015 ACORD CORPURA I IUN. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD