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HomeMy WebLinkAbout109445 CONNELL RESOURCES INC - INSURANCE CERTIFICATE (92)A�� �® CERTIFICATE OF LIABILITY INSURANCE FDATE (MMlDD/YYYY) 5/30/2017 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 endorsement(s). PRODUCER CONTACT Dana Stewart, CIC, CISR NAME: Flood and Peterson PHONE E (970)266-7149 �:(970)506-6845 PO Box 578 ADnRFSR.DStewart@floodpeterson.com Greeley CO 80632 INSURERA:Charter Oak Fire Insurance Company 25615 INSURED INSURER B:Travel era Indemnity Company 25658 Connell Resources, Inc. INSURERC:Travelers Property Casualty Company 25674 7785 Highland Meadows Parkway INSURERD:Pinnacol Assurance 41190 Suite 100 INSURERE: Fort Collins CO 80528 INSURERF: rnVFROrFS rFRTIFICATF NIIMRER.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 A DL U POLICY NUMBER POLICY EFP POLICY EXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X OCCUR DAMAGE TO RNTED PREMISES EaEoccurrence $ 300,000 DTC04794N532COF17 6/1/2017 6/1/2018 MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY II PRO - POLICY 7 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY MBINED SINGLE IT Ea accident $ 1, 000, 000 BODILY INJURY (Per person) $ B g ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS DT8104794N532IND17 6/1/2017 6/1/2018 BODILY INJURY (Per axident) $ PROPERTY DAMAGE Per �cideM $ X UMBRELLA LIAR B OCCUR EACH OCCURRENCE $ 10, 000, 000 RDED AGGREGATE $ 10, 000, 000 C XCESS LIAR CLAIMS -MADE CUP4J906749-17-26 6/1/2017 6/1/2018 I X I RETENTION 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N- OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A y 4029651 6/1/2017 6/1/2018 $ STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT I $ 500, 000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 2161070 - DWRF Engineer Field Office Driveway Grading 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. rFRTIFIrATF Mnl nF:n rANrFI I ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 N. Mason Street ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 D 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)