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HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (85)7�/30/2017 TE (MWDDNYYY) �® CERTIFICATE OF LIABILITY INSURANCE 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 coNTA T NAME: Dana Stewart, CIC, CISR Flood and Peterson HONE (970)266-7149 (Fja. No:(970)506-6845 PO BOX 578 ADDRESS: DStewart0floodpeterson.com 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: COVERAGES CERTIFICATE NUMRFR2017 GL/AU/XS/WC RFVISION NIIMRFR- 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 ADDTYPE OF INSURANCE L SU R POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER YY YYY $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A CLAIMS -MADE X l OCCUR $ 300,000 AMA E RENTED PREMISES Ea occurre MED EXP (Any one person) _ $ 10,000 DTC04794N532COF17 6/1/2017 6/1/2018 PERSONAL & ADV INJURY $ 1,000,000 _ GEN'L GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC $ PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 11000, 000 x BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS DT8104794N532IND17 6/1/2017 6/1/2018 BODILY INJURY (Per accident) $ X PPRBOPERI DAMAGE dn $ HIRED AUTOS X AO OSWNED $ $ UMBRELLA LIAB X JOCCUR EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $ 10, 000, 000 C EXCESS LAB CLAIMS -MADE DED X I RETENTION 10,000 $ CUP4J906749-17-26 6/1/2017 6/1/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N x STATUTE ERA E.L. EACH ACCIDENT $ 500,000 D ANY PROPRIETOR/PARTNER/EXECUTIVE MBER in NH EXCLUDED? ® (Mandatory ( rYi ) N/A 4029651 6/1/2017 6/1/2018 E.LDISEASE- EAEMPLOY $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 I T DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: CRI# 2161081 - Lincoln Avenue Corridor / Phase 2 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. City of Fort Collins 215 N Mason St Fort Collins, CO 80522 GANGELLATIUN 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 Stewart, CIC, CISR/ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)