HomeMy WebLinkAbout365691 BRYAN CONSTRUCTION INC - INSURANCE CERTIFICATE (3)30055
T e
,4coRo CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDNYYY)
4/29/2011
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(les) 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
Wells Fargo Insurance Services USA, Inc.
5755 Mark Dabling Blvd., Suite 300
CONTACT Charles R. Delich
NAME:
EN�IL - 800-332-9256 FAX Net: 719-592-0799
ADDRESS: please Call
INSURERS AFFORDING COVERAGE
NAIL p
Colorado Springs, CO 80919-2228
INSURER A: Valley Forge Insurance Company
20508
INSURED Bryan Construction, Inc.
INSURERS: Continental Casualty Company
20443
INSURER c: Pinnacol Assurance
7025 Campus Drive
INSURER D
NSURER E:
Colorado Springs, CO 80920-3164
INSURER F:
COVERAGES CERTIFICATE NUMBER: 2699233 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
AODL
SUBR
POLICY NUMBER
MWDD/YYYPOLICY F
MMIDD/YYYOLICY P
LIMITS
A
GENERALUABILITY
X COMMERCIAL GENERAL LIABILITY
4029167470
4/30/2011
4/30/2012
EACH OCCURRENCE
$ 1,000.000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ wo,000
CLAIMS -MADE O OCCUR
MED UP (Any oneperson)
$ 15,000
PERSONAL B ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE
LIMIT APPLIES PER
PRODUCTS-COMPIOP AGO
$ 2000,000
POLICY
X PRO LOC
$
B
LIABILITY
4029167484
4/30/2011
4/30/2012
COMBEcNEDilSINGLE LIMIT
L000000
BODILY INJURY(Per person)
$
ANY AUTO
NUTOMOaIUE
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY(Per accitlenl)
$
PROPERTY DAMAGE
Par accident
$
NON -OWNED
HIREDAUTOS X AUTOS
$
Owned PP Au
B
UMBRELLA LAB
OCCUR
L4018050001
4/30/2011
4/30/2012
EACH OCCURRENCE
$ 10.000,000
N
AGGREGATE
$ 10,W0,000
EXCESS LAB
CLAIMS -MADE
DED X RETENTION 10.000
$
Q
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNER/EXECUTIVE❑
2310880
2/1/2011
2/1/2012
g WCSTATU- OTH-
IE
E.L EACH ACCIDENT
1,OW000
$
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
NIA
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
E 1 OW 000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required)
The certificate holder is listed as additional insured in regards to the 7136 Lincoln Center Addition and Renovations project.
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
The ACORD dame and two are registered marks of ACORD 9)1988-2010 ACORD CORPORATION- All rlahts reserved-
ACORD 25 (2010/05) 111111 III III II I II I1111 I II I11111 III III I II 11111I 11111
'CY601A291001090102r02i010'010'