HomeMy WebLinkAbout429212 GLH CONSTRUCTION INC - INSURANCE CERTIFICATEACORD GLHCO-1 03 2CERTIFICATE OF LIABILITY INSURANCE D DATE IMM/5/YY8
CO 08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Rich 6 Cartmill Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
of Colorado LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P O Box 336416 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Greeley CO 80633
Phone:970-356-8030 Fax:970-356-8032 INSURERS AFFORDING COVERAGE NAIC#
INSURED - 'INSURER A'. Bituminous Insurance _Cos
INSURER B. Pi_nnacol Assurance
GLH Construction, Inc. INSURER C.
WiindsorGCO 80550ive INsuaeRD_ _
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
'n
DATE YIE
POLICY OUNFOIT
DATE MMIDDNY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 OOO, O00
PREMISES (Ea ocwrence
$100,000
A
X
X COMMERCIAL GENERAL LIABILITY
CLP3251670
04/01/08
04/01/09
MED EXP(Any one Person)
$5,000
CLAIMS MADE [X] OCCUR
PERSONAL S ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000, 000
GEN'L AGGREGATE LIMIT APPLIES PER.
PRODUCTS - COMP/OP AGG
$2,000,000
POLICY PRQ
JECT LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
CAP3520442
04/01/08
04/01/09
COMBINED SINGLE LIMIT
(Es accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per sodden)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EAACC
AUTO ONLY: AGE
$
'ZANY AU1'0
$
EXCESSIUMBRELLALIABILITY
EACH OCCURRENCE
$5,000,000
A
X I OCCUR �CLAIMSMADE
CUP2581799
04/01/08
04/01/09
AGGREGATE
$5,000,000
$
DEDUCTIBLE
_
$
X RETENTION $ 1O 000
WORKERS COMPENSATION AND
X TORV LIMITS ER
B
EMPLOVERS'LIABILITY
ANY OFFICER/MEMBEREXCLUDED? PROPRIETOR/
XCLUDED?
4028616
07/01/07
07/01/08
E.L. EACH ACCIDENT
$1000000
E.L. DISEASE - EA EMPLOYEE
$ 1000000
B yes, describe Under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$1000000
OTHER
A
Leased / Rented
CLP3251670
04/01/08
04/O1/09
Limit $250,000
Equipment
DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
City of Ft. Collins is named as additional insured on the general
liability policy but only with respect to liability arising out of the
insureds operations on any and all operations by the insured for the
certificate holder. 10 day cancellation provision still applies for
non-payment.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Fort Collins
300 Laporte Ave
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins CO 80522
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Michael J Schmitt CIC
ACORD 25 (2001/08) C9 AGORD CORPORATION 1888
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.
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