HomeMy WebLinkAbout429212 GLH CONSTRUCTION - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDNYYY)
Rich 6 Cartmill Ins of CO
of Colorado LLC
8213 W 20th Street
Greeley CO B0634
Phone 970-356-8030 Fax 970-356-8032
INSURED
GLH Construction, Inc
780 E Garden Drive
Windsor CO 80550
THIS CERTIFICATE IS ISSUED AS A MATTER UH INFURMA I wN
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 __ NAIC #
INSURE1 RA Bituminous Insurance Cos
I INSURER Pinnacol Assurance
HELPER
NSURERD
INSURER E
V VYGrV1VCJ
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REOUIREMENT 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
INS POLICY EF
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIVY) DATE MWDD/YY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE S1,000,000
A IX COMMERCIAL GENERAL LIABILITY
CLP3251670 04/01/08
04/01/09
DAMAGE TO RENTED $ 100 000
PREMISES(Ea occurence) I _,
I ICLAIMS MADE IX1OCCUR
MED EXP(Ariy one person) $5 000 _
PERSONAL BADV INJURY
$ 1 000 000
j
J
GENERAL AGGREGATE
$2 000,000
GEN L AGGREGATE LIMITAPPLIES PER
IPRODUCTS COMP/OP AGG
$2,000,000
POLICY r JECOT LOG
AUTOMOBILE
LIABILITY
I
COMBINED SINGLE LIMIT $ 1 000 000
'
X
A
ANY AUTO
I CAP3520442 04/01/08
I
04/01/09 (Eaac den')
ALL OWNED AUTOS
BODILY INJURY $
(Per person)
SCHEDULED AUTOS
HIRED AUTOS
BODILY INJURY $
NON OWNED AUTOS
I (Per accldenq —
_
PROPERTY DAMAGE $
(Per accidenl)
GARAGE AABIUTY
AUTOONLY EAACCIDENT
$
IANY AUTO
OTHER THAN EA ACC
$
AUTO ONLY AGG
$
EXCESS/UMBRELLA LIABILRY
EACH OCCURRENCE s5,000,000
A
X OCCUR ]CLAIMSMADE
CUP2581799 04/01/08
04/01/09
AGGREGATE s5 000 000
_
s
DEDUCTIBLE
$
X RETENTION $ 10 000
$
WORKERS COMPENSATION AND
X TORV LIMIT51 ER
B
EMPLOYERS LIABILITY
4028616
I _
$
07/01/08 1 07/01/09 EL EACHACCIDENT ~1000000
ANY PROPRIETOR/PARTNER/EXECUTIVE
—
OFFICERMEMBEREXCLUDED'
I
I
EE DISEASE EA EMPLOYEE $ 1000000
Nes describe under
ECIALPROVISIONSbelm
`—
EL DISEASE POLICYLIMIT $ 1000000
OTHER
A
Leased / Rented
CLP3251670 04/01/08 04/01/09
Limit $250,000
IE > ent
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUBInNe "DED BY ENDORSEMENT/ SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATETHEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO 00 SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
REPRESENTATIVES
ACORD 25
L
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
12001/081