HomeMy WebLinkAboutGLH CONSTRUCTION - INSURANCE CERTIFICATE (4)ACORD- CERTIFICATE
OF LIABILITY INSURANCE
DATE( M/ Dom)
05
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins. Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. O. Box 578
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W.18th Street
Greeley, CO 80632
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURERA: Zurich
GLH Construction, Inc.
Black & Silver Ents., L.L.C.
INSURER B:
780 E. Garden Drive
INSURER C:
Windsor, CO BOSSO
INSURER D:
INSURER E:
CUVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
D
NSR
rypE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE M
POLICY EXPIRATION
DATE DDf
LIMITS
A
GENERAL LIABILITY
CP0375796001
09/13/04
04/01/05
EACH OCCURRENCE
$1 000000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 51OCCUR
DAMAGE TO RENTED
s300 DOD
$1 Q 000
MED EXP (Any one person)
X BI/PD Ded:10000
PERSONAL B ADV INJURY
$1 QQQ QQQ
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
POLICY PROT LOC
JEC
A
AUTOMOBILE
LIABILITY
ANY AUTO
CP0375796001
09/13/04
04/01/05
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
-
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
!�
■
coBODILY
�,�
�®
X
INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
-
YJC STATU- OTHER
LIMIT
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
s
ANY PROPRIETOPJPARTNERIEXECUTIVE
E.L. DISEASE - EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
SPECIAL PROVISIONS below I
I
I
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of Ft. Collins is an Additional Insured on the General Liability, but
only with respects to liability arising out of the insureds operations.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Ft. Collins
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRITTEN
P O Box 580
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Fort Collins, CO 80522-0580
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
/Cl000( ,r- '44awso..',l .ra+t✓ra.uta , 2'i.+�,
Z5 (Z001/08) 1 of 2 #M311109 PXP o ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
I1]6'ZdA_11LTA IX0
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
Aa ,VKU Za-a tzuu11uot 2 of 2 #M311109