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HomeMy WebLinkAbout365691 BRYAN CONSTRUCTION INC - INSURANCE CERTIFICATE (2)3 55 A� H CERTIFICATE OF LIABILITY INSURANCE OAT1/272D/YYYY) 27/2012 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 Amber C. Keller NAME: PHONE 800-332-9256 FAx 877-005-9032 -LAIC,.NwEMI: Wells Fargo Insurance Services USA, Inc. E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE "Car 5755 Mark Dabling Blvd., Suite 300 INSURER A: Valley Forge Insurance Company 20508 Colorado Springs, CO 80919-2228 INSURED INSURER 8: Continental Casualty Company 20443 Bryan Construction, Inc. INSURER C Pinnacol Assurance 7025 Campus Drive INSURER D INSURER E : Colorado Springs, CO 80920-3164 1 INSURER F : COVERAGES CERTIFICATE NUMBER: 3867989 REVISION NUMBER: SAn helnw 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 AUOL SUER POLICY NUMBER POLICY EFF MM/DO POLICY EXP MM/DD/YYYY UNITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY 4029167470 4/30/2011 4/30/2012 EACH OCCURRENCE $ 1,000,000 DAMAGES RENTED PREMISES Ea occurrence) $ 300.000 MED EXP (Any one person) $ 15,000 CLAIMS -MADE 1XI OCCUR PERSONAL 8 ADV INJURY $ 1,000.000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY FX I PRO- lErTLOC $ B AUTOMOBILE LIABILITY 4029167484 4/30/2011 4/30/2012 COMBINED SINGLE LIMIT Ea accident) 1,000,000 -X BODILY INJURY (Per person)._ $ - 'ANY AUTO - - --- ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Pl Ber acdtlen) ( S X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per arcmenl $ X $ Owned PP Au I B UMBRELLA LIAB X OCCUR L4018050001 4/30/2011 4/30/2012 EACH OCCURRENCE $ 10,0NDD) AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ NIA 2310880 2/1/2012 2/1/2013 WC STATU- OTH- X ORYLNllTS- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ T"'000 (Mandatory In NH) u yyes, describe ender DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is mqulred) The certificate holder is listed as additional insured in regards to the 7136 Lincoln Center Addition and Renovations project. City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 300 Laporte Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rinhfe resnrvnd ACORD 25 (2010/05)