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HomeMy WebLinkAbout524939 DOUGLASS COLONY GROUP INC - INSURANCE CERTIFICATE (2)A�� (D DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04r2s/zols 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 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 OME:NTA TOnY aJOhnson NA MCGRIFF, SEIBELS & WILLIAMS. INC. PHONE 800-476-2211 - FAX P.O.Box 10265 AAIC, No Extk _ __ (AIC, No):_____ Birmingham, AL 35202 EMAIL COhnson m riR.com ADDRESS: 1 rA INSURERS AFFORDING COVERAGE NAIL# INsuRER A :Continental Casualtv. A CNA Company INSURED Douglass Colony Group Inc. INSURER B :National Fire Ins. Co. OT Hartford 5901 E. 58th Avenue _INSURER C :American Casualty Company of Commerce City, CO 80022 INSURER D INSURER E r•nvcD nc me rcD Tlclr nn'c LIII1.aDCD-GDQMCDU7 Dc\/IQInNI NIIIMRRD 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 TYPE OF INSURANCE A U POLICY NUMBER POLICY EFF MMMD/YYYY POLICY EXP MM/DDNYYY LIMITS B X COMMERCIAL GENERAL LIABILITY 5092131143 05/01/2015 05/01/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGETO .a occ PREMISES .) $ 300.000 MED EXP (Any one person) $. 10,000 i PERSONAL S ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2.000,000 POLICY FX] jEa1:1 LOC PRODUCTS - COMP/OP AGG $ 2,D00,000 $ OTHER B AUTOMOBILE LIABILITY 1 15092130851 05/01/2015 05/01/2016 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Poraccidenq $ ALL OWNED SCHEDULED UTOSAUTOSNON-OWNED HIRED AUTOS X AUTOS Ix PROPERTYL7AMAGE$ Per acc!den l A X UMBRELLA LIAR X OCCUR 1018064481 06/01/2015 05/01/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DIED x I RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTNE 1'�7 OFFICER MEMBER EXCLUDED? u N / A 5092130560 05/01/2015 05/01/2016 )( PER OTH- TE E1_EACH ACCIDENT $ 1,000,00%( (Mandatory in NH) I E.L. DISEASE - EA EMPLOYEES 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORO 101, Additional Remarks Schedule, maybe attached 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. City of Fort Collins 215 N. Mason St. 2nd Floor 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 lV!'�� Pane 1 of 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD