Loading...
HomeMy WebLinkAboutGREYROCK CONSTRUCTION LLC - INSURANCE CERTIFICATEOP ID: BA ACV,R�¢ CERTIFICATE OF LIABILITY INSURANCEFDA TE (MM/DD/YYYY) 11/19/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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 endorsements . PRODUCER 970-635-9400 PFS Insurance Group 970-635-9401 DBA LBN Insurance Agency 4848 Thompson Pkwy, Ste 2OO Johnstown, CO 80534 CONTACT NAME: FAX A/C No: a/Co"N Ext: (A/C. E-MAIL ADDRESS: PRODUCER CUSTOMER ID #: GREYR-1 INSURERS AFFORDING COVERAGE NAIC # INSURED Greyrock Construction, LLC PO Box 271365 Fort Collins, CO 80527 INSURERA:Acuity Insurance Co. 14184 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR OF INSURANCE ADDLTYPE INSR SUER POLICY NUMBER MM IDD YYYY MM/DD YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X PENDING 11/18110 11/18/11 DAMAGE TO RENTED PREMISES Ea occurrence $ 250,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE � OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,000 $ POLICY -PRO LOC AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO N/A BODILY INJURY (Per accident) $ ALL OWNED AUTOS PROPERTY DAMAGE (Per accident) $ SCHEDULED AUTOS HIRED AUTOS $ NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB N/A DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION - AND EMPLOYERS' LIABILITY ,� / N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A VVC STATU- OTH- T Y L I R - E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? El (Mandatory In NH) N / A E.L. DISEASE - POLICY LIMIT 1 $ If yes, describe under DESCRIPTION OF OPERATIONS below A Course of BR 50,00 Construction PENDING 11/18/10 11/18/11 Deductibl 50 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) If required by written contract or written agreement, the Certificate Holder is included as Additional Insured for ongoing operations under General Liability. CITYOFC %,AN%,CLLN 1 IVIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Purchasing Division 2nd Floor AUTHORIZED REPRESENTATIVE 215 North Mason Street Fnr+ rnllinc rn RnAIA ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD