HomeMy WebLinkAboutGE JOHNSON CONSTRUCTION COMPANY - INSURANCE CERTIFICATEPSiCWiBWi
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ACCOR1 fP
L.J .CERTIFICATE OF LIABILITY INSURANCE
DATE (YMIDD)riYY)
of/ls/a01s
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 endorsements .
PRODUCER 1-303-534-4567
INA, Inc. - Colorado Division
NTA T
NAME:
PHONE FAX
AC No:
E
ADDRESS, dempanoginacorp•COa
ORE
1705 17th Street
INSURER 8 AFFORDING COVERAGE
NAIC0
suite 100
INSURER A: PROMIX INS CO (Travelero)
25623
Denver, CO 80202
INSURED
INSURER B: CHARTER OAK FIRS INS CO (Travelers)
25615
O.B. Johnson Construction CoDpany, Inc.
Attn: Accounts Payable
25 North Cascade Avenue, Suite 400
NSURERC: AMERICAN WAR A LIAR INS(Surieh)
26247
INSURER D: PINNACOL ABBOR
41190
INSURERS: EORICH AM R INS CO (Pi.001 A99uranCe)
16535
1 INSURERF:
Colorado Springs, CO 80903
COVFRAGFS CERTIFICATE NUMBER- 42788091 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
TYPEOFINBURANCE
ADOL
Us
POLICY NUMBER
POLICY EFF
MMIO
POLICY EXP
fIRMAD
UNITS
A
X
I COMMERCIAL GENERAL LIABILRY
CLAIMB-MADE I —XI OCCUR
PD Deductible: $5,000
DT000670C701PHX14
10/01/14
10/01/15
EACHOCCURRENCE
$ 1,000,000
PREMISES iEc.,,ml$
1,000,000
X
MEDEXP( a,e non)
$ 5,000
GENL
PERSONAL A ADV INJURY
$ 1,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY[�]JEOCT LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMPIOP ADD
$ 2,000,000
$
B
AUTOMOBILE LIABILITY
ANY AUTO
ALL CVMED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
Ix
DT8100670C701COP14
10/01/14
10/01/15
COMBINED INGLEUMIT _
$ 1,000,000 _
BODILY INJURY(Pw pown)
$
BODILY INJURY(Per eWdoC
$
PROPERTY DAMAGE
Wd
$
$
C
X
UMBRELLA LIAR
EXCESS LIAR
X
OCCUR
I CLAIM"UDE
AUC931908403
10/01/14
10/01/15
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
DED
I I RETENTION$
$
D
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORPARTNEWEXECUTIVE YIN
OFFICERRAEMBER E%CLUDEDT N
(Msndsbry In NMI
If pee doWbe unl
DESCRIPTION OF OPERATIONS baba
NIA
4048587 - CO ONLY
NC463293205-KB,KT,NB,OK,
10/01/14
/01/14
10/01/15
10/01/15
XPSTEARTUTE OR
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
E.L. DISEASE -POLICY LIMB
$ 1.000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddN INne MNal.M. nsl'welheMd N man spas is MUI.Q
Re: All Operations.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580 AUTHORDED REPRESENTATIVE
Port Colllm, CO 80522-0000 / /!,>'if
� USA /A/�/t
®1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
kellYM2013
42788091
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P52W2M2
SUPPLEMENT TO CERTIFICATE OF INSURANCE
DA
01/15//2015
NAME OFINSURED: g,R, Jobnscn Construction Company, Iac.
Attn. Accounts Payable
Additional Descdotion o100erations/Remarks from Pane 1;
Additional IMormatlon:
Contractors Professional a Pollution Liability: Policy #CH0742O165
Insurers IRDIAH HARBOR IRs CO(XL Insurance) Effective Detect: 10/01/14-10/01/15
$5,000,000 Bach Claim Limit; $6,000,000 Aggregate Limit, $50,000 Deductible
SUPP (05M)