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HomeMy WebLinkAboutGRAYCOR CONSTRUCTION COMPANY INC - INSURANCE CERTIFICATE (2)ACOR" CERTIFICATE OF LIABILITY INSURANCE '%_/ DATE (MM/DD/YYYY) 1 5/21 /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 ACIG Insurance Agency, Inc. 2600 N. Central Expwy. Suite 800 CONTACT NAME: PHOJAdC.NEExti; 972.702-9004 FA Nc.No: 972-687-0604 E-MAIL ADDRESS: accountmana erS aci .com Richardson, TX 75080 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: American Contractors Ins. Co. RRG 12300 www.acig.com INSURED Graycor Construction Company Inc. Two Mid America Plaza, Suite 400 INSURER B: ACIG Insurance Company 19984 INSURERC: INSURER D: Oakbrook Terrace IL 60181 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 24773061 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A �/ COMMERCIAL GENERAL LIABILITY lGL15A00016 6/1/2015 6/1/2016 EACH OCCURRENCE $ 5,000,000 A A CLAIMS -MADE ✓ OCCUR IGL15B00016 (GL XS) GL15C00016(GLXS) 6/1/2015 6/1/2015 6/1/2016 6/1/2016 PREMISES eaENI ED encel $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 PR - POLICY F,/� ECT F7 LOC PRODUCTS - COMP/OPAGG $ 5,000,000 $ OTHER A AUTOMOBILE LIABILITY AL15000008 6/1/2015 6/1/2016 COMBINED SINGLE LIMIT Ea accident_ $ 5,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accidents $ NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ B B B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) If OF OPERATIONS below N / A WCA000010015 WCA000005915 WCA000013215 WCA000016315 6/1/2015 6/1/2015 6/1/2015 6/1/2015 6/1/2016 6/1/2016 6/1/2016 6/1/2016 �/ PEATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Contractor License --See Attached Remarks Schedule -- CERTIFICATE HOLDER CANCELLATION City Of Fort Collins P.O. Box 580 330 S. College Ave. Fort Collins CO 80522-0580 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 ; Michael J. O'Neill © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD < 73061 I GRAYCOR 115/16 GL10 AL WC no reduce I Kathy Wilson 1 5/21/2015 10:20:28 AM (CDT) I Page 1 of 2 This certificate cancels and supersedes ALL previously issued certificates. AGENCY CUSTOMER ID: GRAYCOR LOC #: ACORO® ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED ACIG Insurance Agency, Inc. Graycor Construction Company Inc. Two Mid America Plaza, Suite 400 Oakbrook Terrace IL 60181 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) HOLDER: City Of Fort Collins ADDRESS: P.O. Box 580 330 S. College Ave. Fort Collins CO 80522-0580 AL - If these policies are cancelled, non -renewed or materially changed, 60 days notice, except 10 days for nonpayment of premium, will be mailed to the Certificate Holder. GL - If these policies are cancelled, non -renewed or materially changed, 60 days notice, except 10 days for nonpayment of premium, will be mailed to the Certificate Holder. WC - If these policies are cancelled, non -renewed or materially changed, 60 days notice, except 10 days for nonpayment of premium, will be mailed to the Certificate Holder. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM/DOO 24773061 1 GRAYCOR 1 15/16 GL10 AL WC no reduce I Kathy Wilson 1 5/21/2015 10:20:28 AM (CDT) I Page ' of This certificate cancels and supersedes ALL previously issued certificates.