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Home My WebLink AboutGRACE COMMERCIAL - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE DATE 01/29/2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BROOKS INS # 255/METRO INS AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6655 W. JEWELL AVE . , SUITE 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. LAKEWOOD, CO 80232 INSURERS AFFORDING COVERAGE INSURED GRACE COb2X1ERCIAL BUIL 1901 S. NAVAJO STREET DENVER, CO 80223 :OVERAGES i m /UL4 INSURERACONTINENTAL WESTERN INSURER B: PINNACOL ASSURANCE 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 DATE MMIDDIYY POLICY EXPIRATION DATE MMfDDIVY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 7 OCCUR CWP2486401 09/29/2003 / / 09/29/2004 / / EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE jAny one fire $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYF_Xl jEC LOC PRODUCTS - COMPIOP AGG $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS CWP2486401 09/29/2003 / / / / 09/29/2004 / / / / COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO / / / / AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS X LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ CU2487857 09/29/2003 / / 09/29/2004 / / EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 SELF INS RETENTION $ 10,000 $ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 4043458 06 /O1 /2003 06/01/2004 WCSTATU- OTH- 7pRY LIMITS X ER E.L. EACH ACCIDENT Is 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT I $ 1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS COMMERCIAL FRAMING, ROUGH CARPENTRY, DRYWALL, TILE WORK, INCIDENTAL WELDING AND INTERIOR TRIM NORMAL TO DECORATIVE IRON/STEEL PRODUCT INSTALLATION. BLANKET ADDITIONAL INSURED END. # CG2033 INCLUDED ON GENERAL LIABILITY POLICY. j;a 970 -ZzY — C(f y CITY OF FORT COLLINS P O BOX 580 FORT COLLINS, CO 80522 ACORD 25S (7/97) * A INS025S (991oyot SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO rjlSLlGalON OR LIABILITY OF ANY KIND UPON THE AUTHORIZED REPRESENTATIVE 4 S I!jE4RjWASER FdRMS, INC. - (BOO)327-0545 ® ACORD CORPORATION 1988 Page 1 of 2 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. ACORD 25-S (7197) ]6,, INS025S (geio).oi Page 2 of 2