HomeMy WebLinkAboutG E JOHNSON CONSTRUCTION - INSURANCE CERTIFICATEACOR-P„ CERTIFICATE OF LIABILITY INSURANCE 1DATE (MWD
0/170/17/08D/YY)
PRODUCER 1-303-534-4567 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INA of Colorado, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202 INSURERS AFFORDING COVERAGE
INSURED
G.E. Johnson Construction Company, Inc.
Attn: Accounts Payable
25 North Cascade Avenue, Suite 400
Colorado Springs, CO 80903
L:UVILHA61=6
INSURER D: Travelers Prop. Casualty Co. of America
INSURER C. Argonaut Insurance Company (Pinnacol As
INSURER D: Pinnacol Assurance
E:
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.
II T R TYPE OF INSURANCE POLICY NUMBER
POLICY EFFECTIVE POLICY E%PIRATIONT LIMITS
A
GENERAL LIABILITY
DTC00670C701IND08
10 /Ol/08
10/01/09
EACH OCCURRENCES
I$ 1, 000, 000
X COMMERCIAL GENERAL LIABILITY
F1 IRE DAMAGE(Anyonelire)
I$1,000,000
CLAIMS IX_
MADE OCCUR
MEDCXP(Any one person)
$5 000
X PC DED: $25,000
PERSONAL &ADV INJURY
$ 1, 000,000
X Annual Agg Ded$100,000
_
GENERAL AGGREGATE
$ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS COMP/OP AGO
52, 000, 000
POLICY I X I PRO X LOC
E
AUTOMOBILE
LIABILITY
DT8100670C701TIL08
10/O1/08
10/01/09
nSINGLE LIMIT
g1, 000,000
X
ANY AUTO
(Ea accident)
ALL OWNED AUTOS
--
BODILY INJURY
S
SCHEDULED AUTOS
(Per person)
r
X
HIRED AUTOS
DODINJURY
$
NON -OWNED AUTOS
acc
(Per accitlent)
PROPERTY DAMAGE
3
(Per accident)
GARAGE LIABILITY
,AUTO ONLY -EA ACCIDENT$
! OTHER THAN EA ACC
ANY AUTO
$
AUTO ONLY: AGG
B
EXCESS LIABILITY
DTSMCUP0670C701TIL08
10/01/08
10/01/09
EACH OCCURRENCE
$ 5,000,000
X_ OCCUR JCLAIMS MADE
I
-
AGGREGATE
S 5_000, 000
_
g
DEDUCTIBLE
I
X RETENTION g10, 000
S
C
WORKERS COMPENSATION AND
47723822270 - CA ONLY
10/01/08
10/O1/09
X WRYLIMIU R
— _-""'
EMPLOYERS'LIABILITY
------_—'-"
E.L. EACH ACCIDENT
_
$ 100 000
E L. DISEASE - EA EMPLOYE
5100,000
E. L. DISEASE - POLICY LIMIT
$500,000
OTHER
D
Workers Compensation
4048587 (CO ONLY)
10/01/08
10/01/09 IEL
Each Accident s 100, 000
Employers' Liability
EL Disease Be Empl s 100,000
WC Statutory Limits
EL Disease Policy s 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: All Operations.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins 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
PO Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Fort Collins, CO 80522-0000 AUTHORIZED REPRESENTATIVE S
USA
ACORD 25-S (7/97) crunderwood ra ACORn CORPORATION t ORA
1U1V1L/4
Certificate Delivery by CertificatesNow - www.ConfirmNet.com - 87T669.8600
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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