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Home My WebLink AboutGREYROCK CONSTRUCTION LLC - INSURANCE CERTIFICATE (2)GREYR-1 OP ID: BA ,A` oRo CERTIFICATE OF LIABILITY INSURANCE DAT10/2711 1 o/27n 1 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 PFS484 Insurance Group, St 4848 Thompson Pkwy, Ste 200 CONTACT NAME970-635-9401 PHONE FAX AIC No Eat), LAIC, No): Johnstown, CO 80534 Johnstown Select Accounts EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC a INSURER A: Acuity Insurance Co. 14184 INSURED Greyrock Construction, LLC PO Box 271365 INSURER B: Fort Collins, CO 80527 INSURERC: 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 TYPE OF INSURANCE ADDL INSR SUBS Man POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDD/YYri LIMITS GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE II OCCUR X X05887 11112/11 11/12/12 AMA T RENTED PREMISES Ea occurtence E 250,00 MED EXP (Any one person) E 10,000 PERSONAL B ADV INJURY E GENERAL AGGREGATE E 3,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG E 3,000,000 POLICY 7 PRO- LOG E AUTOMOBILE LIABILITY Ea BINEDpaceISINGLE LIMIT $ BODILY INJURY (Per person) 'S ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS - BODILY INJURY (Per arsltlenl ) E NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Peraccltlenl E $ UMBRELLA LIAB OCCUR EACH OCCURRENCE E AGGREGATE E EXCESS LU\B CLAIMS -MADE DED RETENTIONS S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y I H ANY PROPRIETOR/PARTNEREXECUTIVE OFFICERIMEMBER EXCUJDED9 ❑ NIA I E.L. EACH ACCIDENT E E.L. DISEASE -EA EMPLOYEE E (Mandatory In NH) u yes, deun'be under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLIGY LIMIT E A Course of X05887 11/12/11 11/12/12 BR 50,00 Construction Ded 50 DESCRIPTION OF OPERATIONS / LOCATIONS I 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 City of Fort Collins Purchasing Division 2nd Floor 215 North Mason Street 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 V 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD