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HomeMy WebLinkAboutGE JOHNSON CONSTRUCTION COMPANY - INSURANCE CERTIFICATE (2)QP52600290112 x 1 DATE(MM/DD/YYYY) " AC40RV CERTIFICATE OF LIABILITY INSURANCE 09/21/2015 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 1-303-534-4567 CONTACT NAME: IMA, Inc. - Colorado Division PHONE FAX 1705 17th Street Suite 100 Denver, CO 80202 INSURED G.S. Johnson Construction Company, Inc. Attn: Accounts Payable 25 North Cascade Avenue, Suite 400 Colorado Springs, CO 80903 ADDRESS: QOD=cOIIIILLecnsNlIDacOiy-COM INSURE S AFFORDING COVERAGE MAIL 0 _ INSURERA: TRAVELERS PROP CAS CO OF AMER 25674 INSURER B: CHARTER CZAR FIRE INS CO (Travelers) 25615 INSURER CAXERICAN GUAR i LIAB INS (Zurich) 26247 INSURER 0: ZURICH AURR INS CO (Pinnaeol Assurance) 16535 INSURERS: PINNACOL ASSUR 41190 INSURER F: INDIAN HARBOR INS CO (XL Insurance) 136940 CAVFRArF3 CFRTIFICATF MIIURFR• 45D25451 RFVISIAN Fit1ru1RFR• 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 466L1SUBA EFF POLICY EXP -_.. - _ _ ____.. _-_ ._... LTR TYPE OF INSURANCE POLICY NUMBER MM/DD MM/DO LIMITS A X COMMERCIAL GENERAL LIABILITY DTC0067OC701PHX15 10/01/15 10/01/16 EACHOCCURRENCE $ 1,000,000 CLAIMS -MADE 1111 OCCUR E( RENTEDEa occurrence) PREMISES = 1,000,000 Z MED EXP (Any one person) $ 5,000 PD Deductible: $5, 000 _ PERSONAL BADVINJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE It 2,000,000 GENT POLICY I IPEOT [ LOG PRODUCTS - COMP/OP AGG i 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY DT8100670C701COF15 10/01/15 10/01/16 COMBINED SINGLE LIMIT ffa accident) $ 1,000,000 BODILY INJURY (Per person) $ AUTO IANY ALL OWNED SCHEDULED AUTOS AUTOS BODILYINJURY(Peraccident) $ NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Peraccident f C X UMBRELLA Luke Z OCCUR AUC931908404 10/01/15 10/01/16 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAR CLAIMS -MADE DIED Z RETENTION $ 0 S D B WORKERTION AND YERS'LSAILIT AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDE& N/A WC463293206-RS,NT,NE,OX, 4048587 - CO ONLY /01/15 10/01/15 10/01/16 10/01/16 Z STATUTE OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE f 1, 000, 000 (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT f 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: All Operations. L,CK I nr i%.,A I G rIULUCK GANI.tLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 580 AUTHORIZED REPRESENTATIVE /;# Fort Collins,CO 80522-0000 usA ((( ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD kellym2013 4S025451 0 , - P526W2WX)2 SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE 09/21/2015 NAME OF INSURED: G.B. Johnson Construction Company, Inc. Attn: Accounts Payable Additional Description of Operations/Remarks from Page 1: Additional Information: Contractors Professional a Pollution Liability: Policy #CE0742016501 Insurer F: Bee Above Effective Dates: 10/01/15-10/01/16 $6,000,000 Each Claim Limit; $8,000,000 Aggregate Limit; $50,000 Deductible SUPP (05/04)