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HomeMy WebLinkAbout498970 HILL ENTERPRISES INC DBA PETROLEUM - INSURANCE CERTIFICATE (2)a DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE F,2/28/2016 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 endorsements . PRODUCER CONTNAMEACT TrueNorth Risk Mgmt CSG-CO TrueNorth P"°NE 720 491 5411 FAX 303-776 5495 500 1st 5t SEC. Cedar Rapids IA 52401 AQQRESS: certs@truenorthcompanies_com INSURER A: Nationwide Agribusiness Insurance C 28223 INSURED HILLENT-01 INSURER B:Pinnacol Assurance Company 41190 Hill Enterprises, Inc INSURERC: DBA Hill Petroleum -- 6301 Ralston Road INSURERD: Arvada CO 80002 INSURER-E:__ Crl\/FRAr:FC CERTIFICATE IUI IMRFD• 1256082303 DF\/ICInFJ 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR I POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY CPP104980A 1/1/2017 1/1/2018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X� OCCUR -DAPREMISES IS occurrence E100,000 MED EXP (Anyone person) E5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO ❑ JECT LOC F—IE PRODUCTS - COMP/OP AGG E 2,000,000 OTHER: A AUTOMOBILE LIABILITY CPP104980A 1/1/2017 1/1/2018 Ea accident E1,000,000 X BODILY INJURY (Per person) E ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS E BODILY INJURY (Per accident) HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Per accident E — — _ E A X UMBRELLA LIAB %( OCCUR CU104980A 1/1/2017 1/1/2018 EACH OCCURRENCE i 55,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE' DED X RETENTIONEO E B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNERIEXECU I VE OFFICER/MEMBER EXCLUDED? NI (Mandatory in NH) NIA 4148287 6/1/2016 6/1/2017 X I STATUTE I I 0ERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEq -- $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT — Fs1,000,000 A Transportation(Cargo) IMC137475A 1/1/2017 1/1/2018 Limit 100,000 Deductible 5,000 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'] insd forms Gen Liab #CGLB303 0413 and Auto #CCAB191 1013. If Yes is indicated above for waiver of subrogation forms Gen Liab #CGLB304 0310, Auto Liab #CCAB191 1013 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 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. AUTHO IZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD