HomeMy WebLinkAboutG. E. JOHNSON CONSTRUCTION COMPANY INC - INSURANCE CERTIFICATE�FSSHXIStlWS
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A� be CERTIFICATE OF LIABILITY INSURANCE
°09 6/21YD0° 4
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: H the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. N 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
certHlcate holder in lieu of such andorsemen s .
PRODUCER 1-303-534-4567
IDEA, Inc. - Colorado Division
E:CONTACT
NAY
PHONE FAX
AF No:
ADDRESS: roa denpemBicorp. com
1705 17th Street
Suite 100
Denver, CO 80202
INSURE S AFFORDINGCOVEAAGE
MCI
INSURER A: PHOBLTIE INS CO (Travelers)
25623
INSURED
INSURER B: CHARTER OAR FIRS INS CO (Travelers)
25615
U.B. Johnson Construction Company, Inc.
Attn: Accounts Payable
INSURERC: AMBRICAN GUAR A LIAR INS(Zurich)
26267
INSURER D: ZURICH AfmB INS CO (Pinnacol)
16535
25 North Cascade Avenue, Suite 600
INSURERE: PINNACOL ASSUR
61190
Colorado Springs, CO 80903
INSURER F: INDIAN HARBOR INS CO(EL Inecrance)
36960
COVERARFS CERTIFICATE NUMBER- 41610946 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
Lim
TYPEOFWSURANCE
AO01
WEIR
POLICY NUMBER
MAIDIYEFF
MMMIDDFYYY
LIYRB
A
GEMERALUABILTY
DTL0067OC701PM14
10/01/1
10/01/15
EACHOCCURRENCE
s 1,000,000
I COMMERCIAL GENERAL LIABILITY
PREMISES b
f 1,000,000
CL us-NADE Fi-I OCCUR
MED EXP e,a
f 5,000
PERSONALAADV WWRY
51,000,000
E PD Deductible: $5.000
GENERAL AGGREGATE
f 2,000,000
GENLAGGREGATEUMITAPPLIES
PER:
PRODUCES -COMP,OP AGO
f 2.000,000
f
POLICY
I PRO- 21 Loc
JECT
B
AUTOMOBILE
jUrBI0067OC701COFIA
COMBINED SINGLELIMIT
IF. m. _-.__
.1,000,000._
BODILYIIMURY(Po, e )
f
E
ANY AUTO
ALL OWNED SCHEDULED
TOS AUTOS
BODILY IWURY(Pw acWenl)
f
POPERY DOGE
f
E
HIIRED AUTOS AUTO ED
f
C
I
UYBRELLALUB
I
OCCUR
ADC931908403
1010111
10/01/15
EACH OCCURRENCE
f 5,000.000
AGGREGATE
f 5,000,000
EXCESS LAD
CLAW3MAOE
CEO I I RETENTION
f
D
B
WORMERS COYPENUMN
AND EMPLOYER, UABILrrY
ANY PROPRIETOWPARTNER,EXECUTIVE YIN
OFFICERIMEMBER FXCLUDEDi )
NIA
NCe63293206-IB,NT,NR,OI,
4068587 -CO ONLY
E10/01/1
10/01/1
10/01/15
10/01/15
EITIR WC STATU- OTH-
JR
E.L. EACH ACCIDENT
f 1,000,000
(WndMwy In MM)
E1. OISEASE-EA EMPLOYEE
f 1,000,000
2ei describe
SCRIPTON OF OPERATIONS
El. DISEASE -POLICY LIMIT
$ 1, 000, 000
DESCRIPTION OF OPERWDOM01 LOCILTION31 VEHICLES (ANSN ACORD 101, AddXNItl RwAehe SSAeduM. tl mon epees N Mubed)
Res All Operations.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
y of Port Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Box 580 AUTHORED REPRESENTATIVE % /]
t Colliae, CO 80522-D000 ` /`A
OSA
01OW2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105)
peeper
a1610946
The ACORD name and logo are registered marks of ACORD
PSE6W$WMI$
SUPPLEMENT TO CERTIFICATE OF INSURANCE
DATE
09/26/3014
NAME OF INSURED: G.B. Johnson Construction Company, Inc.
Attn: Accounts Payable
Additional Description of OpemboralRemarks trom Page 1:
Additional Information:
Contractors Professional A Pollution Liability: Policy YCE07120165
Insurer F. See Above Effective Dates: 10/01/14-10/01115
$5,000,000 Each Claim Limit, $6,000,000 Aggregate Limitr $50,000 Deductible
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SUPP (05/04)