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HomeMy WebLinkAboutGRAYCOR CONSTRUCTION COMPANY INC - INSURANCE CERTIFICATE (4)A� �® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/21/2018 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 have ADDITIONAL INSURED provisions or 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 Ex w . Suite 800 Richardson, TX 75 8 CONTACT NAME: PHONE FAX 972-702-9004 A/c No: 972-687-0601 E-MAIL ADDRESS: accountmana ers aci .com INSURERS AFFORDING COVERAGE NAIC # INSURERA: 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: 1 INSURER D: Oakbrook Terrace IL 60181 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 42011577 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 MMIDD/YYYY LIMITS A V COMMERCIAL GENERAL LIABILITY GL18A00016 6/1/2018 6/1/2019 EACH OCCURRENCE $10000000 A A CLAIMS -MADE ./ OCCUR GL18B00016 (GL Excess) GL18B00016 (GL Excess) 6/1/2018 611/2018 6/1/2019 6/1/2019 DAMAGE TO RENTED PREMISES Ea occurrence $ 100 000 MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $ 1 O 00O 000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 POLICY ✓� ECT F LOC PRODUCTS - COMP/OP AGG $ 1 O 000 000 $ OTHER: A AUTOMOBILE LIABILITY AL18000008 6/1/2018 6/1/2019 EOaaccdenMBINEDtsINGLELIMIT $5,000000 BODILY INJURY (Per person) _ $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR DED I I RETENTION $ $ B B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑N N / A WCA000010018 WCA000005918 WCA000013218 6/1/2018 6/1/2018 6/1/2018 6/1/2019 6/1 /2019 6/1/2019 V/ STATUTE OERH E.L. EACH ACCIDENT $ 1 ,000,000 B (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below WCA000020918 6/1/2018 6/1/2019 E.L. DISEASE - EA EMPLOYEE $ 1 E.L. DISEASE - POLICY LIMIT $ 1 00O 000 DESCRIPTION OF OPERATIONS I LOCATIONS / 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 42011577 1 GRAYCOR 1 18119 GL 10 AL WC I Kathy Wilson 1 5/21/2018 2:14:36 PM (CDT) I Page 1 of 2 This certificate cancels and supersedes ALL previously issued certificates.