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Client#: 1559798 131 FINFRHOL
ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)
12/21 /2018
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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CON
NAME: _
McGriff Insurance Services PHONEeat):407 691-9600 88&635-4183
A/C, No, (A/C, No):
PO BOX 4927 IL
Orlando, FL 32802-4927 ADDRESS: _
407 691-9600 INSURER(S) AFFORDING COVERAGE _ NAIC #
INSURER A: --I- 22322
INSURED XL S I I C 37885
Finfrock Holdings, Inc
Finfrock Construction, LLC*
2400 Apopka Blvd
INSURER B: Peclaty neuranoo ampony
INSURER C : Amorlsure Insurance company
D:
Apopka, FL 32703 INSURER E :
INSURER F
COVERAGES CERTIFICATF NIIMRFR: 1Q/90 Mactpr RAIRWSP RFVISIr1N NIIMRFR•
19M
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 CONTRACTOR 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,
LTRR
TYPE OF INSURANCE _
kDDL
INSR
UBR
WVD
_ POLICY NUMBER
POLICY EFF
MM/DDNYYY
01101/2019101/01/2020
i POLICY EXP
MM/DI/YYY
-
LIMBS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
BVPD Ded:$10,000
X
CGG740965601
I
EACH OCCURRENCE
$1 000 000
QAMAGE T RENTED
RO SEA occurrence
$3�000
X
GEN'L
MEDEXP(Anyonepomon)
. ___ _ ___
$10000
PERSONAL & ADV INJURY
$1 10001wo
AGGREGATE LIMIT APPLIES PER:
yPRO- j�
POLICY L�I JECT A 1 LOC
OTHER:
GENERAL AGGREGATE
$2,000 000
PRODUCTS-COMPIOP AGG
$2 OOO 000
$
A
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY X AUTOS ONLY
X
CAH740965701
1/01/2019
1/01/2019
01/01/2
E°MaBodeD SINGLE LIMIT
1,000 000
BODILY INJURY (Per person)
$
BODILY INJURY (Peraccide"
$
PROPERTY DAMAGE
Per aec,den
_
$
B
X
UMBRELLA LIAB
EXCESS LIAO
X
OCCUR
CLAIMS -MADE
US00082024L119
01/01/2
EACH OCCURRENCE
$1 O 000 000
AGGREGATE
$10 000,000
DED X RETENTION $10 OOO
$
`.
WORKERS COMPENSATION
AND EMPLOYERS' LIl1 BILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVEr —
OFFICERIMEMBER EXCLUDED? 'JN
(Mandatory In NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
X
I
WC210718201
1/01/2019
01/01/2020
X PERTUTE JOTH.
E.L. EACH ACCIDENT
-`-----'-"`—
$1 000 000
E.L. DISEASE - EA EMPLOYEE
$1 000 OOO
E.L. DISEASE - POLICY LIMIT
$1 0009000
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more spats is required)
*Named Insured Continued: Finfrock Architecture and Engineering, Inc; Finfrock Architecture and
Engineering, LLC; Finfrock Construction, Inc; Finfrock DC, Inc; Finfrock Design, Inc; Finfrock Design, LLC;
Finfrock Design -Manufacture -Construct, Inc; Finfrock Design -Manufacture -Construct, LLC; Finfrock
Enterprises, LLC; Finfrock Financial, LLC; Finfrock Industries, Inc; Finfrock Industries, LLC; Finfrock
Properties, Inc; Finfrock Properties, LLC; Finfrock Transportation, Inc; Finfrock Transportation, LLC;
(See Attached Descriptions)
I t HULUEH
City of Fort Collins
PO BOX 580
Fort Collins, CO 80522
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
ACORD 25 (2016/03) 1 of 2
9516 #S22601411/M22600914
"\r
01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
CLHO
page 3 of 3
DESCRIPTIONS (Continued from Page 1)
Toronto, LLC; Structure Works, LLC; and Finfrock Development, LLC.
General Liability: Additional Insured including completed operations is granted with if required by written
contract or agreement per Additional Insured (Blanket) Form Endorsement CG2010 04/13 and CG2037 04113.
Primary and Non -Contributory is granted if required by written contract per Primary Insurance Clause
Endorsement XIL424 06/05. Waiver of Subrogation status is granted if required by written contract per
Waiver of Transfer of Rights Endorsement CG2404 05/09.
Automobile Liability: Additional Insured status is granted if required by written contract per Automatic
Additional Insured's Endorsement XIC411 10/13. Primary and Non -Contributory is granted with if required by
written contract per CA044911/16. Waiver of Subrogation status is granted if required by written contract
per Waiver of Transfer of Rights of Recovery Against Others To Us Endorsement CA0444 10/13.
Workers' Compensation: Waiver of Subrogation is granted if required by written contract per Waiver of Our
Right to Recover from Others Endorsement form WC000313 04/84.
Umbrella Policy: Follow form over General Liability, Auto Liability and Employers Liability.
SAGITTA 25.3 (2016/03) 2 of 2
#S22601411 /M22600914
9517