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HomeMy WebLinkAbout579783 AMERICAN PIPELINE SERVICES - INSURANCE CERTIFICATE (2)ACORiX CERTIFICATE OF LIABILITY INSURANCE 10/1/2018 F DATE(MM/DD/YYYY) 1 10/1/2017 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 Lockton Companies CONTACT oph FAX A/c Na Ext : AIC No): 8110 E. Union Avenue Suite 700 Denver CO 80237 E-MAIL ADDRESS: IN R AFFORDING COVERAGE N IC p (303) 414-6000 INSURER A: The Travelers Indemnity Company 25659 INSURED American Pipeline Services INSURER B : The Charter Oak Fire Insurance Company 25615 1343601 700 Billings Street, Unit L Aurora, CO 80011 INSURER C : Travelers Property Casualty Cc of America 25674 INSURER D : PlnndC01 Assurance Comyany 41 190 INSURER E; Greenwich Insurance Company 22322 INSURER F : COVERAGES CERTIFICATE NUMBER: 14492336 REVISION NUMBER: XXXXXXX 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 LTR TYPE OF INSURANCE ADDL INSD SUBR l POLICY NUMBER POLICY EFF MM/D /YYYY POLICY EXP MMIDO/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR PD Ded.: $5-000 Y N DTC0326DO565 10/1/2017 10/1/2018 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISE Ea occurrence 3OO OOO X MED EXP (Any oneperson) 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY JERCOT- ❑ LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 21000,000 $ B AUTOMOBILE LIABILITY ANY AUTO AUTOS ONLY SCHEDULED AUTOS AUTOS ONLY X ED NON-OWNED ONLY Y N DT810326DO565 10/1/2017 10/1/2018 IND EOM accidentSINGLE LIMIT) $ 11000,000 X BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXX X PROPERTY rr.CEcRd.rrtJ GE $ XXXXXXX $XXXXXXX C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N DTSMCUP326DO565 10/1/2017 10/1/2018 EACH OCCURRENCE $ 51000,000 X AGGREGATE $ 51000,000 DED I X I RETENTION $ 10,000 $ XXXXXXX D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AN OFFICER/MEMBER EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE I (Mandatory in NHI If yes, describe under DESCRIPTION OF OPERATIONS below N / A N 4121983-CO 10/1/2017 10/1/2018 X STATUTE ER E.L. EACH ACCIDENT $ I OOO OOO E.L. DISEASE - EA EMPLOYEE 1 000 000 E.L. DISEASE - POLICY LIMIT 1,000,000 E Pollution N N PECO02832608 10/1/2017 10/1/2018 Limit: $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Arthur Ditch -Canyon Avenue, Grout Joint Repair. The City of Fort Collins, its officers, agents and employees are listed as Additional Insured with respects to General Liability and Auto Liability if required by written contract. 30 day notice of cancellation is provided to certificate holder. CERTIFICATE HOLDER GANGtLLAI IUN gee AaacnmeniS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14492336 AUTHORIZED REPRESENTATIVE The City of Fort Collins attn: Purchasing Department PO Box 580 Fort Collins CO 80522 f ACORD 25 (20161031 ©1 8 015 ACORD CORPOKATION. All rights reserved The ACORD name and logo are registered marks of ACORD