CT2017-1402 COI

• Contract/PO #: CT2017-1402
• Contractor Name: North Poudre Irrigation Company
• Contract Type: Loan
• Loan Projects - Doc Type: Contract Documents

l ® DATE(MM/DD/YYYY)
A`cRD CERTIFICATE OF LIABILITY INSURANCE
4/16/2018
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 CONTACT
NAME:
F&W Insurance PHONE
3005 Center Green Drive, Suite 120 fA(C.No,_Ext)t 303-444-4666 FAC. No,. 303 444-8481
E-MAIL
Boulder CO 80301 ADDRESS
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:American Alternative Insurance Corp 19720
INSURED F&WOVER-36 INSURER B:Pinnacol Assurance Compares -__ _ 41190
The North Poudre Irrigation Company INSURER C:
P.O. Box 100
Wellington CO 80549 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1587888639 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.
TYPE OF INSURANCE ADSL SUBRI _-
POLICY EFF
INSR POLICY EXP
LTR INSD WVD'� POLICY NUMBER (MM/DD/YYYY) (MMIDDIYYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY GPPAPF605551305000 3/10/2018 3/10/2019 EACH OCCURRENCE $1,000,000
I DAMAGE TO RENTE
CLAIMS-MADE ' X OCCUR PREMISES Ea occur ence) $1,000,000
MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: IGENERAL AGGREGATE $3,000,000
11 POLICY PRC JECT I 1 l LOC PRODUCTS-COMP/OP AGG $3,000,000
I
1 OTHER: $
3/10/2018 3/10/2019 COMBINED SINGLE LIMIT $1,000,000
AUTOMOBILE LIABILITY GPPAPF605551305000 (Ea accident)
X ANY AUTO BODILY INJURY(Per person) $
I OWNED SCHEDULED I BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE , $
X AUTOS ONLY X AUTOS ONLY (Per accident)
I $
A X UMBRELLA LIAB XOCCUR 1 GPPAPF605551305000 3/10/2018 3/10/2019 EACH OCCURRENCE $10,000,000
EXCESS LIAB CLAIMS-MADE I AGGREGATE $10,000,000
1 DED ! j RETENTION$ F ! $
B WORKERS COMPENSATION 4020277 6/1/2017 '', 6/1/2018 X STATUTE I K
H-
AND EMPLOYERS'LIABILITYF
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N/A I
(Mandatory in NH) I DISEASE-EA EMPLOYE $1,000,000
If yes,describe under E.L.�I
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
A Inland Maine GPPAPF605551305000 3/10/2018 3/10/2019 See Schedule
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Colorado Water Conservation Board THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1313 Sherman St,Ste 718 ACCORDANCE WITH THE POLICY PROVISIONS.
Denver CO 80203
AUTHORIZED REP-ESENTATIVE
©1988-2015 ACORD� CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD