HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (81)7TE (MM/DD/YYYY)
ACoRo® CERTIFICATE OF LIABILITY INSURANCE
30/2017
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 endorsements).
PRODUCER CONTACT Dana Stewart, CIC, CISR
NAME:
Flood and Peterson A/C E : (970) 266-7149 FAIC N: (970)506-6845
PO Box 578 E-MAIL DStewart@floodpeterson.com
ennaass• P
INSURERS AFFORDING COVERAGE NAIC •
Greeley CO 80632 INSURERA:Charter Oak Fire Insurance Company 25615
INSURED INSURERB:Travelers Indemnity Company 25658
Connell Resources, Inc. INSURER C:Travel era Property Casualty Company 25674
7785 Highland Meadows Parkway INSURERD:Pinnacol Assurance 41190
Suite 100 INSURERE:
Fort Collins CO 80528 INSURERF:
CAVFRAGFS CERTIFICATE NUMRER-2017 GL/AU/XS/WC 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE F OCCUR
$ 300,000
DAMAGE TO RENTED
PREMISES Ea occurrence)
MED EXP (Anyone person)
DTC04794N532COF17
6/1/2017
6/1/2018
$ 10,000
PERSONAL & ADV INJURY
$ 11000,000
GENT AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X JECT LOC
POLICY [xi
PRODUCTS - COMP/OPAGG
$ 2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SIN LE LIMI
Ea accident
$ 11000,000
BODILY INJURY (Per person)
$
B
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS _d AUTOS
DT8104794N532IND17
6/1/2017
6/1/2018
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident)
ccident
$
NON -OWNED
X HIRED AUTOS X AUTOS
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 10, 000, 000
AGGREGATE
$ 10, 000, 000
C
EXCESS LIAB
CLAIMS -MADE
DIED . X I RETENTION$ 10,000
$
CUP4,7906749-17-26
6/1/2017
6/1/2018
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? N
(Mandatory in NH)
N/A
4029651
6/1/2017
6/1/2018
][PER
STATUTE ER
E.L.EACH ACCIDENT
$ 500,000
E.L. DISEASE.- EA EMPLOYEE
$ 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CRI# 2171021- Seckner Alley Sewer Bursting
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.
CFRTIFICATF Hnl nFR CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
4316 LaPorte Avenue
ACCORDANCE WITH THE POLICY PROVISIONS.
Fort Collins, CO 80522
AUTHORIZED REPRESENTATIVE
D Stewart, CIC, CISR/�r-
U 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)