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HomeMy WebLinkAboutG.E. JOHNSON CONSTRUCTION COMPANY INC - INSURANCE CERTIFICATE (3)P526W26W2 AC"Rbr CERTIFICATE OF LIABILITY INSURANCEDATE /201 YY) o9/a6/2o17 09/2 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 Inc. - Colorado Division NAME:PHONE -� FAX ' . C 1705 17th Street ADDRESS: denaccounttechs4imacorp.com INSURERS AFFORDING COVERAGE NAIC8 Suite 100 INSURERA: CHARTED OAK FIRE INS CO(TRAVRtJW INS C )I5615 Denver, CO 80202 INSURED INSURERS: TRAVELMS IND CO 25658 G.B. Johnson Construction Company, Inc. INsuRERc: ANSRICAN GUAR A LIAB INS(Zuriob Amrical,26247 Attn: Accounts Payable INSURERD: ZURICR ANER INS CO (Pinaacol Assurance) 16535 25 North Cascade Avenue, Suite 400 INSURERE: PINNACOL ASSDR 41190 INSURER F: INDTAN HARBOR INS CO(XL Insurance) 36940 Colorado Springs, CO 80903 1 COVERAGES CERTIFICATE NUMBER: 50953106 RFVISION NIIMRFR- 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/DDIYYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I x I OCCUR DTC00670C701COF17 10/01/17 10/01/18 EACHOCCURRENCE DAMAGE ( RENTED PREMISESS Ea occurrence)>< = 1,000,000 1,000,000 X MED EXP (Any arm person) : 5,000 PD Deductible: $5, 000 PERSONAL & ADV INJURY $ 1.000,000 AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC GENERAL AGGREGATE $ 2,000,000 GENL PRODUCTS - COMP/OP AGG $ 2, 000, 000 $ OTHER: B AUTOMOBILE LIABILITY DT8100670C701IND17 10/01/17 10/01/18 COMBINED SINGLE LIMIT Ea accdent $ 1,000,000 BODILY INJURY (Per person) $ Y ANY AUTO I _ _ ALL OWN AUTOS ED AUTOSULED BODILY INJURY (Per accident) $ Y Y NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ C X UMBRELLA LIAB X OCCUR AUC931908406 10/01/17 10/01/18 EACH OCCURRENCE $ 5,000,000 EXCESS LU\B CLAIMS -MADE _ AGGREGATE $ 5,000,000 DED X RETENTION $ 0 $ D E AND EMPLOYERS' TION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? NIA WC463293208-KS,MT,NE,OK, 4048587 - CO ONLY /01/17 10/01/17 10/01/18 10/01/18 Y STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEd $ 1,000,000 (Mandatory In NH) H yes, describe under E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: All Operations. 1 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 MO 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 briannah 50953106 Fn M M 00 2 W V52&*28(X,2 SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE 09/26/2017 NAME OF INSURED: G.B. Johnson Construction Company, Inc. Attn: Accounts Payable Additional Description of Operations/Remarks from Page 1: Additional Information: Contractors Professional & Pollution Liability: Policy #CE0742016503 Insurer F: See Above Effective Dates: 10/01/17-10/01/18 $6,000,000 Each Claim Limit; $8,000,000 Aggregate Limit; $50,000 Deductible SUPP (05/04)