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HomeMy WebLinkAbout524939 DOUGLASS COLONY GROUP INC - INSURANCE CERTIFICATEAo �® CERTIFICATE OF LIABILITY INSURANCE DATE04123/DDYYYY' 04/23I2014 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, ANDTHE 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 MCGRIFF, SEISELS B WILLIAMS, INC. P.O. Box 10265 CONTACT Tony.Johnson NAME: PHONE 800-476-2211 FAX : (AIC, No, Ext): (__NP) E-MAIL ADDRESS:tjohnson@mcgriff.com Birmingham, AL 35202 INSURER(S) AFFORDING COVERAGE NAIGtl INSURER A:Continental Casualty, A CNA Company INSURED Douglass Colony Group Inc. INSURER 9:National Fire Ins. Co. of Hartford INSURER C'American Casually Company of Reatling, PA 5901 E. 58th Avenue Commerce City, CO 80022 INSURER 0 INSURERS INSURER F : COVERAGES CERTIFICATE NUMBER:6XV5TPDg 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. IDOLTSUBRI LTPOUCYEXP R TYPE OF INSURANCE AINSR I WVD POLICY NUMBER MMIDDIYYriPOUCYEFF MMIDDIYYYYI LIMITS B GENERAL LIABILITY 5092131143 05/01/2014 0510112015 EACH OCCURRENCE IS 1.000.000 X COMMERCIAL GENERAL LIABILITY OAGETO-REN AM PREMISES Ea ocounaroO I S 300,000 CLAIMS MADE 111 OCCUR MED EXP (Any one person) $ 10,000 PERSONAL B ADV INJURY S 1.000,000 GENERAL AGGREGATE S 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 1-1 POLICY f X I PER,, n LOC I I S B AUTO MOBILE LIABILITY 5092130851 05101/2014 05/01/2015 COMBINED SINGLE LIMIT Ea accident) IS 1,000,000 _ BODILY INJURY (Per person) 5 X ANY AUTO OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per asoxi $ PROPERTY DAMAGE Per amident $ X NON OWNED HIRED AUTOS N AUTOS Is A X UMBRELLA LIAR X I OCCUR 14018064481 05/01/2014 05/01/2015 EACH OCCURRENCE Is 5,000.000 AGGREGATE s 5,000,000 EXCESS LIAR CLAIMS -MADE DED X( RETENTION$ 10,000 Is C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE 5092130560 OSI01/2014 OSI0112015 X WCSTAT1L OT TQRY �IMIT� ER E.L. EACH ACCIDENT $ 1,000000 OFr:CE RMEstBER EXCLOOED? ❑ NH) If N I A EL. DIGEAg�Lk EMPLCYEEj g 1,CAO.000 Ryes, describe antler yes, describe DESCRIPTION OF OPERATIONS below ( E.L. DISEASE- POLICY LIMIT $ 1,000,000 $ $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Roof Replacement at Drake Wastewater Treatment Plant, Project Number: 7529 Certificate Holder and any and all parties are Additional Insureds with respects to General Liability and Automobile Liability as required by written contract. General Liability coverage is primary and noncontributory as required by written contract. Policy limits limited to that which are requested in the written contract. Waiver of Subrogation applies when required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE 215 N. Mason St. 2nd Floor PO Box 580 / n yI � P Fort Collins, CO 80522 �,.iGJ.•.�'.oa.l Z fa ACORD 25 (2010/05) Page 1 of 1 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD