2016-08-29_PERMIT FILE - C1981035A (45)

Home Browse Search

A� o CERTIFICATE OF LIABILITY INSURANCE DATE(MMND/YYW) 15 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 CONTACT om' NPHONE Aon Risk services southwest, Inc. Houston TX office (AIC, No, Ext): (866) 283-7122 F (800) 363-0105 E-MAIL ADDRESS: 5555 San Felipe suite 1500 Houston TX 77056 USA INSURER(S) AFFORDING COVERAGE NAIC M INSURED INSURER A: American Zurich Ins Co 40142 GCC Energy, LLC 6473 County Road 120 Hesperus Co 81326 USA INSURER 8: Zurich American Ins Co 16535 INSURER C: Liberty Insurance Underwriters, Inc. 19917 INSURER D: INSURER E: FTSkTTI15$1,000,000 PREMISES Ea occurrence WSURER F: COVERAGES CERTIFICATE NUMBER: 570059161954 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. Limits shown are as requested LTR TYPE OF INSURANCEINSOY�1ID POLICY NUMBER NEFF FOUCY XP LIMITS X COMMERCIAL. GENERAL LIABwITy GLO EACH OCCURRENCE $2,000,000 CLAIMS-MADEX❑OCCUR FTSkTTI15$1,000,000 PREMISES Ea occurrence MED EXP (Arty one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIESPER GENERAL AGGREGATE $4,000,000 X POLICY ❑ PRO- ❑ LOCJECT PRODUCTS - COMP/OP AGG $4,000,000 OTHER, B AuTomoeLELIAR SAP 6551242-06 09/01/2015 09/01/2016 COMBINED SINGLE LIMIT $1,000,000 pdentl BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS Per PROPERTY PERTY DAMAGE $1000 Call Dad $1000 Comp Dad c x UMBRELLA LIAB I x I OCCUR 10000593 505 09/01/201S 09/01/2016 EACH OCCURRENCE $2S,000,000 EXCESS UAB CLAIMS -MADE AGGREGATE $25,000,000 DED RETENTION ProducLaCompleted 0 $25,000,000 e WORKERS COMPENSATION AND EMPLOYERS' LLJ 1ABTY YIN ANY PROPRIETOR I PARTNER I EXECUTIVE OFFTCERIMEMBER EXCLUDED? N (Mandatory in NFg N I A WC655 24006 69 1 1s 09/01/2016 X I PER ORT'-'- STATUTE E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 I es, dsrnbe under DESCRIPeTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addkknal Remarks Schedule, may be aeachad M more apace is nqulrad) RE: OSM Permit CO -0106 and CDRMS Permit CD -1981-035. Marc and Julie Crawford are included as Additional insured in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Marc and Julie Crawford AUTHORIZED REPRESENTATIVE 2323 County Road 121 Hesperus CO 81326 USA e.JKan `%3x � 01988-2014 ACORD CORPORATION. All rights reserved ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD a S