HomeMy WebLinkAboutDRILLPRO SERVICES INC - INSURANCE CERTIFICATE (6)DATE (MM/DDIYYYY)
A�COR" CERTIFICATE OF LIABILITY INSURANCE e/29/2017
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 Peter Foley
y
Moody Insurance Agency, Inc. AI NE . (303) 824-6600 No: (303)370-0118
8055 East Tufts Avenue E-MAIL ADDRESS: peter .fole @moodlns.com y y
Suite 1000 INSURE S AFFORDING COVERAGE NAICM
Denver CO 80237 INSURERA:Cincinnati Indemnity Com a 123280
INSURED
DrillPro Services, Inc.
2220 E 74th Pl Unit A
I INSURER C:Homeland Ins Co of NY 134452 1
Thornton CO 80229 I INSURERF:
COVERAGES CERTIFICATE NUMBER:17-18 W/ Forms 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 EFF POLICY EXP LIMITS
LTR POLICY NUMBER MM D MM D
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE l x l OCCUR
DAMAGE TA
FIR SESOEa oNcur ence
$ 500,000
MED EXP (Any one person)
$ 10,000
X
EPP0208312
9/1/2017
9/1/2018
PERSONAL BADVINJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X POLICY JECT PRO ❑ LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
A
X ANY AUTO
ALL OSCHEDULED
AUUTOSS AUTOS
X
EBA0208312
9/1/2017
9/1/2018
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
NON -OWNED
HIRED AUTOS AUTOS
X
UMBRELLA LIAR
X
OCCUR
EACH OCCURRENCE
$ 2,000,000
FIDED
AGGREGATE
$ 2,000, 000
A
EXCESS LIAB
CLAIMS -MADE
I X IRETENTION$ 0
$
EPP0208312
9/1/2017
9/1/2018
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
g STATUTE ER
E.L. EACH ACCIDENT
$ 100 000
OFFICER/B (MandatoryEMBER m NH EXCLUDED? ❑
( ry � )
NIA
A
4023119
9/1/2017
9/1/2018
E.L. DISEASE - EA EMPLOYE9
$ 100,000
If es, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1 $ 500,000
C
Pollution Liability
X
7930002730006
9/1/2017
9/1/2018
Limit $2,000,000
Deductible $ 5 , 0 0 0
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Fort Collins is included as additional insured with respect to General and Automobile Liability
as required by written contract, and Pollution Liability.
rGOTICIr ATC urll 1111=0 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
Operations Services
ACCORDANCE WITH THE POLICY PROVISIONS.
117 N Mason St
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80521
Peter Foley/PETFOL
U 1938-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)