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HomeMy WebLinkAbout365691 BRYAN CONSTRUCTION INC - INSURANCE CERTIFICATEAC40R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 1/31/2011 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 endorsement(s). PRODUCER Commercial Lines - (719) 592-1177 CONTACT NAME: PHONE FAX AI C NoE-MAIL Wells Fargo Insurance Services USA, Inc. 5755 Mark Dabling Blvd., Suite 300 ADDRESS: PRODUCER 30055 CUSTOMER ID M Colorado Springs, CO 80919-2228 INSURERS AFFORDING COVERAGE NAIC # INSURED Bryan Construction, Inc. INSURER A: Travelers Indemnity Company of America 25666 INSURER e : Travelers Property Casualty Company of America 25674 INSURER C : Continental Casualty Company 20443 7025 Campus Drive INSURER D : Pinnacol Assurance INSURER E : Colorado Springs, CO 80920-3164 INSURER F : - COVERAGES CERTIFICATE NUMBER: 2324369 REVISION NUMBER: See below 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDIYYYY LIMITS A - - GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE r_x1 OCCUR - DTC07323A5481ND10 4/30/2010 4/30/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: -- POLICY M-PRO--- _ — LOC PRODUCTS - COMP/OP AGG $ 2,000,000 - - $ - - B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Owned PP Autos DT8107323A548TIL10 4/30/2010 - 4/30/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ Owned Other Than PP X $ C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE L4018050001 4/30/2010 4/30/2011 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DEDUCTIBLE RETENTION $ 10,000 $ X $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 2310880 - 2/1/2011 2/1/2012 X WC STATU- OTH- LIMIT E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 T_ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The certificate holder is listed as additional insured in regards to the 7136 Lincoln Center Addition and Renovations project. FICA City of Fort Collins 300 Laporte Avenue Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 003439 The ACORD name and logo are registered marks of ACORD © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009I09) I IIIIIII III IIIIIII IIII IIIII IIIIII IIII (IIII IIIII IIIII IIIII IIIII IIIIIIIIIIIIIII IIIII IIII IIII ------------