HomeMy WebLinkAboutGLH CONSTRUCTION - INSURANCE CERTIFICATE (2)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DP DATE(MMIDDIYYYY)
GLHCO-1 03 31 09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Rich & Cartmill Ins of CO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
of Colorado LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
8213 W. 20th Street
Greeley CO.80634
Phone:970-356-8030 Fax:970-356-8032
INSURED
GLH'Construction, Inc.
780--E Garden Dr
Windsor CO 80550
COVERAGES '
INSURERS AFFORDING COVERAGE NAIC #
INSURER A. Bituminous Insurance Cos 20095
INSURER B: Pinnacol Assurance
INSURER C
INSURER D:
INSURER 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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE ( CY MFDD/Y )
POLICY(EXPIRATION
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
(Ea occurence)
$100,000
A
X
X COMMERCIAL GENERAL LIABILITY
CLP3262772
04/01/09
04/01/10
-PREMISES
MED EXP (Any one person)
s5,000
CLAIMS MADE Fx� OCCUR
PERSONAL 8 ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
POLICY PRO LOC
JECT
A
AUTOMOBILE
LIABILITY
ANY AUTO
CAP3529215
04/01/09
04/01/10
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000.
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
-NON-OWNED AUTOS
-PROPERTY DAMAGE _.
(Per accident)
$ .
_7 _
_..... ._ .
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
_
$
OTHER THAN EA ACC
.AUTO ONLY: - -�.._. -"
AGG
$
.
ANY AUTO
$
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$5,000,000
A
X OCCUR F-1CLAIMSMADE
CUP2585015
04/01/09
04/01/10
$
HDEDUCTIBLE
$
X RETENTION $ 10 , 000
WORKERS COMPENSATION AND
X T'OR Y 'MI Ti ER
LI
B
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
4028616
07/01/08
07/01/09
E.L. EACH ACCIDENT
$1000000
E.L. DISEASE - EA EMPLOYEE
_
$ 1000000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$ 1000000
OTHER
A
Leased / Rented
CLP3262772
04/01/09
04/01/10
Limit $250,000
,'Equipment
DESCRIPTION OF OPERATIONS I LOCATIONS I 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.
r`GDTICIf`ATG Unl nGD 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
Fort Collins CO 80522
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Michael J Schmitt CIC
ACORD 25 (2001/08) v A%IVMU t1VMrvrw 1IVN 1 Voo
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 (2001/08)