HomeMy WebLinkAboutG E JOHNSON CONSTRUCTION - INSURANCE CERTIFICATE (2)Client#: 20042
GEJOHNS
ACOBQ CERTIFICATE OF LIABILITY
INSURANCE
10/071ZDim
PRODUCER
IMA of Colorado, Inc.
1550 17th Street, Suite 600
Denver, CO 80202
303 534-4567
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURED
G.E. Johnson Construction Company, Inc.
25 North Cascade Avenue, Suite 400
Colorado Springs, CO 80903
INSURER A: St. Paul Fire 8: Marine Insurance Co.
INSURER B: Lexington Insurance Company*
INSURER C: Pinnacol Assurance
INSURER D: Argonaut Ins Co (Pinnacol)
INSURER E: *Risk Specialists
COVERAGES
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
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
X COMM ERCIALGENERAL LIABILITY
CLAIMS MADE FXI OCCUR
X BI/PDDed25,000
KC08300271
$100,000 Annual Agg
10/01104
10/01105
EACH OCCURRENCE
$1 O0O 000
FIRE DAMAGE (Any one fire)
$100000
MED EXP (Any one person)
$5 000
PERSONAL SADVINJURY
$1000000
LAE as event
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIM IT APPLIES PER:
POLICY X PRO-LOC
PRODUCTS -COMPIOPAGG
$2000000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
KC08300271
10/01/04
10/01/05
COMBINED SINGLE LIMIT
(Ea accident)
$1 00O
, ,000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
It
OTHER THAN EA ACC
AUTO ONLY: AGO
S
$
A
B
EXCESS LIABILITY
X OCCUR ❑ CLAIMS MADE
DEDUCTIBLE
X RETENTION $10000
KC08300271
8782672*
10/01/04
10/01104
10/01/05
10101/05
EACH OCCURRENCE
$5 000 000
AGGREGATE
$5 000,000
*Limit
$5 000 000
*Aggregate
$5 000 000
$
C
D
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
**CA & NM
4048587*
47675822270**
**$500,000
**$1 000 000
10/01/04
10/01/04
*CO Only
1 Pol Limit
10/01/0$
10/01/05
Ea Empl
I
X WC STATU- OTH-
E.L. EACH ACCIDENT
$100,000
E.L. DISEASE -EA EMPLOYEE
$100,000
I E.L. DISEASE -POLICY LIMIT
1 $500000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Re: All Operations.
City of Fort Collins
PO Box 580
Fort Collins, CO 80522
SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30_-_DAYSWRITTEN
NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVE
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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).
DISCLAIMER
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.
ACORD25S(7/97)2 of 2 #M230856