C150363 Insurance

• Contract/PO #: C150363
• Contract/PO #: CT2015-001
• Contractor Name: Petrocco Family Limited
• Contract Type: Loan
• Water District: 2,3
• County: Adams
• County: Larimer
• Loan Projects - Doc Type: Contract Documents

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'`'C°RO CERTIFICATE OF LIABILITY INSURANCE DATE(M 101255/2013/2013Y)
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 endorsement(s).
PRODUCER Phone: [phone] NAMEACT
Phil Broncucia Agency PHONE FAX
1970 Kipling Street Fax: [phone] INC.No.Exn: (A/C,No):
Lakewood,CO 80215 E-MAIL
Broncucia House ADDRESS:
PRODUCER PETRO-1
CUSTOMER ID#:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED Petrocco Family Ltd Partnershp INSURER A:Travelers
David Petrocco Farms, Inc
14110 Brighton Road INSURER B:
Brighton,CO 80601 INSURERC:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL(SUBR POLICY EFF .POLICY EXP LIMITS
LTR INSR IWVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY)
1 GENERAL LIABILITY EACH OCCURRENCE I$ 1,000,000
A X COMMERCIAL GENERAL LIABILITY 7003337C203 03/01/2013 03/01/2014 DAMAGE TO RENTED
PREMISES(Ea occurrence) $ 50 000
CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 1,000
PERSONAL&ADV INJURY $ 1,000,000
■ GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
X POLICY JECT PRO LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
A ANY AUTO BA-3337C203 03/01/2013 03/01/2014 (Ea accident)
BODILY INJURY(Per person) $
X ALL OWNED AUTOS
BODILY INJURY(Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE
X I HIRED AUTOS I (Per accident) i
X NON-OWNED AUTOS
$
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 20,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 20,000,000
A - ZFSEX3337C203/55038703 03/01/2013:03/01/2014-
DEDUCTIBLE $
X RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE - N/A E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A Property Section 7003337C203 03/01/2013 03/01/2014 lblkt cont 400,000
A Rented/Leased 7003337C203 1 03/01/2013103/01/2014 Equipment 50,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
CERTIFICATE HOLDER CANCELLATION
COLORWA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Colorado Water Conservation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Co ACCORDANCE WITH THE POLICY PROVISIONS.
Board
1580 Logan St. STE 600
Denver, CO 80203 AUTHORIZED REPRESENTATIVE
©1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD