CT2017-3641 COI

• Contract/PO #: CT2017-3641
• Contractor Name: The North Poudre Irrigation Company
• Contract Type: Loan
• Loan Projects - Doc Type: Contract Documents

l ® DATE(MM/DD/YYYY)
ACORD 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 PHONEF
3005 Center Green Drive, Suite 120 uu. Mo,Fxt) 303-444-4666 (vC.Nol' 303 444 8481
E-MAIL
Boulder CO 80301 ADDRESS
INSURER(S)AFFORDING COVERAGE _ _ NAIC S
INSURER A:American Alternative Insurance Corp 19720
INSURED F&WOVER-36 INSURER B:Pinnacol Assurance Company 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.
INSR I -- - - IADDLTSUBR'- - POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY),(MM/DD/YYYY) LIMITS
A x I COMMERCIAL GENERAL LIABILITY GPPAPF605551305000 3/10/2018 3/10/2019EACH OCCURRENCE I$1,000,000 _-
IDAMAGETORENTED $1,000,000
CLAIMS-MADE I X I OCCUR PREMISES(Ea occurrence)
MED EXP(Any one person) $10,000
_PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000
X POLICY r� JEt° 1_._J LOC PRODUCTS-COMP/OPAGG $3,000,000
OTHER:'' $
k AUTOMOBILE LIABILITY GPPAPF605551305000 3/10/2018 3/10/2019 (Ea aBINEDt)INGLE LIMIT $1,000,000
X ANY AUTO BODILY INJURY(Per person) $
OWNED I I SCHEDULEDI,
AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
— -
HIRED NON-OWNED PROPERTY
OP TYDAMAGE $XAUTOS ONLY x AUTOS ONLY ( r accident)
A X UMBRELLA LIAB X GPPAPF605551305000 3/10/2018 3/10/2019 EACH OCCURRENCE $10,000,000
OCCUR
EXCESS LIAB CLAIMS-MADE. AGGREGATE $10,000,000
DED ' I RETENTION$ $
B WORKERS COMPENSATION 4020277 6/1/2017 6/1/2018 X PER ! OTH-
AND EMPLOYERS'LIABILITY I STATUTE I I ER
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N'N/A
E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N/A I `--- --
(Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
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/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