HomeMy WebLinkAboutGF TECHNOLOGIES INC DBA COMPLETE BASEMENT SYSTEMS - INSURANCE CERTIFICATE (3)COMPBAS-01 CPOPE
A�oRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
9/8/2015
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).
CONTPRODUCER NAME., Chad Pope
Forsberg Engerman Co PHONE,IHo Exf ; (303) 762-1717 Fa No): (303) 762-1733
3575 S Sherman St E-MAIL
Englewood, CO 80113 ADDRESS: info@forsberg-engerman.com
INSURED
GF Technologies Inc dba Complete Basement Systems
3250 Quentin St Ste 114
Aurora, CO 80011-1841
INSURERS) AFFORDING COVERAGE NAIC #
INSURER A: Knight Specialty Insurance Company 15366
INSURER B: EMC Insurance Companies 21415
INSURER C :
INSURER D :
01=VICIr1Nl IVI IMRFR-
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
ADDL UBR POLICY EFF POLICY EXP
ILTR NSR TYPE OF INSURANCE p POLICY NUMBER MM/DD/YYW MM/DD/YYYY LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE OCCUR
❑X
X
KSVENA150020706
08/30/2015
08/30/2016
DAMAGET RE ED
PREMISES Ea occurrence
$ 50,000
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$ 1,000,000
GENTAGGREGATE LIMIT APPLIES PER:
X
POLICY PRO- LOC
JECT
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS-COMP/OPAGG
$ 2,000,000
OTHER:
AUTOMOBILE LIABILITY(Ea
accIident)NED SINGLE LIMIT
$ 1,000,000
BODILY INJURY (Per person)
$
B
X ANY AUTO
5X33689-16
08/30/2015
08/30/2016
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
X X NON -OWNED
HIRED AUTOS AUTOS
DA
P.rraccld I) MAGE
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DIED RETENTION $
WORKERS COMPENSATION
PER OTH-
STATUTE ER
$
E.L. EACH ACCIDENT
$
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
NIA
E.L. DISEASE -POLICY LIMIT
If yes, describe under
DESCRIPTION OF OPERATIONS below
$
B
Equipment Floater
5X33689-16 08/30/2016
08/30/2016
Included
B
Property
5X33689-16 08/30/2016
08/30/2016
200,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Fort Collins is named as an additional insured with respect to general liability per CG2026 07/04 as required by contract.
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Kaye Mathea
PO Box 580
Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE
V 19II14 AL.UKU L UMrUKH I IV N. Au nlyllw ICDCI VGU.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD