HomeMy WebLinkAbout486984 GRANITE INLINER LLC - INSURANCE CERTIFICATE (2)P52Nu2aa12
R AC<>Ra" CERTIFICATE OF LIABILITY INSURANCE o9 �3%20 9M
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 WANED, 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 LIC NOC36861 1-415-403-1491 CONTACT NAME: Kimberly Leikam
Alliant Insurance Services, Inc. PNONE .415-403-1491 FAx No. 415-874-4018
100 Pine Street, lath Floor
San Francisco, CA 94111
INSURED
Granite Inliner, LLC
585 West Beach Street
UUC No
AMONes. kleikem0alliout.ccan
:VALLEY FORGE Ise aG
COUTnUXTAL CAB CO
.TRANSPORTATION INS CO
[Watsonville, CA 95076 (INSURER F:
PMICOAITCe PCDTICM`ATC M1 WOCG- R7207RR2 0=1114u u MILMIRCO-
20509
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.
LT R
OF INSURANCE
ADDLTYPE
2=
SUER im
POLICY NUMBER
MYNDY EFF
Maw E%P
LIMITS
A
Z
CO BtCIALGENERALLIABILITY
I
M41074970689
10/01/18
10/01/21
EACH OCCURRENCE
S 2.000,000
CLAIMS -MADE F—x1 OCCUR
DAMAGE TO RENTED
PREMISES Es ocaurence
$ 2,000,000
I
MED EXP (Any One pawn
$ Nil
ICD
I
Contractual Liability
PERSONAL S ADV INJURY
$ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
S 10,000,000
POLICY � a I —xi LOC
PRODUCTS -COMPIOP AGG
S 2,000,000
$
OTHER:
A
AUTOMOBILE LUIBILITY
Z
BOA2074976692
10/01/18
10/01/21
COMBIN MEwD1SINGLE LIMIMe T
$ 2,000,000
BODILY INJURY (Par Parson)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
II
BODILY INJURY(Pw aodderd)
S
PROPERTY DAMAGE
Mar accident)
$
I HIRED I NON -OWNED
AUTOS ONLY AUTOS ONLY
$
B
X
UMBRELLALJAB
I
OCCUR
CUR2068209453
10/01/19
10/01/20
EACH OCCURRENCE
$ 8,000,000
AGGREGATE
S 810001000
I
EXCE33 LIAR
I CLAIMS -MADE
DED RETENTION
$
A
C
C
WORKER8COMPENSATIOM
AND EMPLOYERS' LIABILITY IN
ANYPROPRIETORIPARTNERIEXECUTIVE Y❑
OFFICER(MEMBEREXCLUDED?
(Mandatory In NH)
NIA
WC274978644 (AOS/StopGaV
WC274978661 (NT,WI,HI)
WC274978658 (NY)
10/O1/19
10/01/19
10/01/19
10/01/20
10/01/20
10/01/20
I PTASATUTE ETR
E.L. EACH ACCIDENT
S 2,000,000
E.L.DISEASE-EAEMPLOYEE
S 2,000,000
E.L. DISEASE -POLICY LIMIT
$ 2.000,000
A
If
PERATIONS below
DDyes des<nhe undeRIPTION OF OPERATIONS
ESC
WC274978630 (CA)
10/01/19
10/01/20
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddRlenal Remarks Schedule, may be attached R mon apace Is required)
Certificate holder is included as an Additional Insured on the General Liability and Automobile Liability policies as
required by written contract subject to policy terms, conditions and exclusions.
GL Per ISO Form CG 0001 10/01; AL Per ISO Form CA0001 10/13
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
OF FORT COLLINS, COLORADO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
LAPORTE AVE. I AUTHORIZED REPRESENTATIVE
COLLINS, CO 80522
USA v
01988-2915 AGORD CORPORATION. All nghts reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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