HomeMy WebLinkAbout564493 G ORR CONSTRUCTION LTD - INSURANCE CERTIFICATE (5)74/7/2017
TE (MM/DD/YYYY)
AR" " CERTIFICATE OF LIABILITY INSURANCE
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 CONTACT Renee McReynolds
NAME: y
Ewing -Leavitt Insurance Agency, Inc. AIONN Ex : (970) 679-7344 FAX No: (666)425-6180
4090 Clydesdale Parkway AIL
ADDRESS:renee-mcreynolds@leavitt.com
Suite 101 INSURERS AFFORDING COVERAGE NAIC #
Loveland CO 80538 INSURERA:Cincinnati Insurance Co 10677
INSURED INSURER B :Pinnacol Assurance 41190
G Orr Construction Ltd INSURER C :
201 Commerce Drive INSURER D :
Unit #1 INSURER E:
Fort Collins CO 80524 INSURER F:
rr1VFRA('.FS rFRTIFIrATF NIIMRFR•17-18 RFVISION NIIMRFR-
T HIS 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 TYPE OF INSURANCE ADDL SUBR'I POLICY NUMBER MM/DDY LTR IYYYY MM/DDNYYY LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE FxI OCCUR
PREMISES Ea occur ence
$ 500,000
x
MED EXP (Any one person)
$ 10,000
incl Blkt WOS
ENP0433109
4/15/2017
4/15/2018
x
incl Blkt Addl Insureds
PERSONAL BADVINJURY
$ 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2 , 000 , 000
POLICY a PRO -
POLICY ❑ LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
1
$
OTHER:
I
1
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1f000,000
BODILY INJURY (Per person)
$
A
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
ENP0433109
4/15/2017
4/15/2018
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
NON -OWNED
X HIRED AUTOS X AUTOS
single limit
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y 1 N
ANY PROPRIETOR/PARTNER/EXECUTIVE
x PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 100,000
B
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N I A
4187053
11/1/2016
11/1/2017
E.L. DISEASE - EA EMPLOYE
$ 100,000
If Yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
i _
$ 500,000
A
Contractors' Equipment
ENP0433109
4/15/2017
4/15/2018
$50,000Leased/Rented
$500 deductible
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate holder will be given 30 day written notice should the insurance be cancelled or non -renewed;
however 10 day notice will apply in the event of non-payment of premium. Certificate holder, its
officers, agents and employees are named as additional insureds as respects general liability.
rFRTIFIrATF HOI nFR CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins
P O Box 580
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Fort Collins, CO 80522
AUTHORIZED REPRESENTATIVE
R McReynolds/RESTEI�_
V 18SS-ZU14 ACUhQ) cUF(FL)KAI IL)N. All rlgnts reserVea.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)