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HomeMy WebLinkAbout524939 DOUGLASS COLONY GROUP INC - INSURANCE CERTIFICATE (3)�- ® ACORLU CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 05/13/2015 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 MCGRIFF, SEIBELS & WILLIAMS, INC. P.O. Box 10265 CONTACT a Ton Johnson NAME: y PHONE FAX (A/C No Ext) $00 476-2211 (A/C, No): _ E-MAIL ADDRESS: tjohnson@mcgriff.com Birmingham, AL 35202 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Continental Casualty, A CNA Company INSURED Douglass Colony Group Inc. INSURER B :National Fire Ins. Co. of Hartford 5901 E. 58th Avenue INSURER C : INSURER D Commerce City, CO 80022 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:N8DXR5QV 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 TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY B X COMMERCIAL GENERAL LIABILITY 5092131143 05/01/2015 05/01/2016 EACH OCCURRENCE $ 1,000,000 F_V_1 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ 300,000 IVIED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � JE� LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: I I B AUTOMOBILE LIABILITY 5092130851 05/01/2015 05/01/2016 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS X AUTOS PerOa RTY DAMAGE $ $X A X UMBRELLA LIAB X OCCUR 4018064481 05/01/2015 05/01/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE 5092130560 05/01/2015 05/01/2016 X PER OTH- 'TAT. TE R E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT If yes, describe under DESCRIPTION OF OPERATIONS below 1000,000 $ , DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins 215 N. Mason St. 2nd Floor PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 jj Page 1 of 1 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD