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Home My WebLink AboutON DEMAND CONCRETE LLC - INSURANCE CERTIFICATE 2021-2022IC� � DATE IMM/DDNWYI �.....- CERTIFICATE OF LIABILITY INSURANCE ��9�� 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), AUTHORI2ED 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 PRODUCER FEDERATED MUTUALINSURANCE COMPANY HOME OFFICE: P.O. BOX 328 OWATONNA, MN 55060 E-MAIL INSURER(S) AFFORDING COVERAGE NAIC # iNsuRER n: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 188-044-2 �NSURER B: ON DEMAND CONCRETE LLC INSURER C: 1501 BACKHOE RD LOVELAND, CO 80537-8903 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 78 REVISION NUMBER: 5 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSIJED 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 7VPE OF INSURANCE ADDL SUBR pOLICV NUMBER POLICY EFF POLICY EXP LIMITS LTR IIVSR WVD MMIDD/VVVV MM/DD/YYYV X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $� �OOO�OOO CLAIMS-MADE ❑X OCCUR PREMISES�Ea oN uErence $��,�� MED EXP (Any one person) $$,000 A Y Y 6115485 04/01/2021 04/01/2022 PERSONAL& ADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $Z,OOO,OOO POLICY � �E�T ❑ LOC PRODUCTS - COMP/OP AGG S2�OOO�OOO OTHER: AU70MOBILE LIAeILI7Y COMBINED SINGLE LIMIT $'I,OOO,OOO Ea attitlent X ANY AUTO BODILV INJURV (Per persan) OWNED AU705 ONLV SCHEDULED A AUTos Y N 6115485 04/01/2021 04/01/2022 B�DILY INJURY (Per accidentj HIRED AUTOS ONLV NON-OWNED PROPERTY DAMAGE AUTOS OfVLY Per a<citlent X UMeRELLA LIAe X OCCUR EACH OCCURRENCE $5,000,000 /� EXCESS LIAB CLAIMS-MADE N N 6115486 04/01/2021 04/01/2022 AGGREGATE $5,��,�00 DED RETENTION WORKERS COMPENSATION X PER STATUTE OTH- AND EMPLOYERS' LIABILITY ti. � N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $'I,OOO,OOO A OFFICER/MEMBER EXCLUDE�? � N� A N 1812726 04/01/2021 04/01/2022 �Mandatory in NH� E.L. DISEASE - EA EMPLOYEE $� �� If yes, descri6e untler DESCRIPTION OF OPERATIONS helow E.L DISEASE - POLICY LIMIT $�,OOO,OOO �ESCRIPTION OF OPERATIONS / LOCATIOfVS / VEHICLES (ACORD 101, AdAi[ional Remarks ScheAule, may 6e attatlietl if more spa<e is requiretl) SEE ATTACHED PAGE CERTIFICATE HOLDER 188-044-2 CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO 80522-0580 ACORD 25 (2016l03) CANCELLATION 78 5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEO REPRESENTATIVE . � �� 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 188-044-2 f�,,� LOC #: AClJRL��' 1..•---"" ADDITIONAL REMARKS SCHEDULE Page � ot � AGENCY NAMEDINSURED FEDERATED MUTUALINSURANCECOMPANY ON DEMAND CONCRETELLC POLICY NUMBER 1501 BACKHOE RD SEE CERTIFICATE # 78.5 LOVELAND, CO 80537-8903 CARRIER NAIC CODE SEE CERTIFICATE # 78.5 EFFEcrivE oarE: SEE CERTIFICATE # 78.5 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE POLICY COVERAGE AS OF 04/28/2021 THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIREU IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE AD�ITIONAL INSURE� BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. GENERAL LIABILITY CONTAINS A WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC ENDORSEMENT GENERAL LIABILITY COVERAGE CONTAINS CG 25 03 DESIGNATED CONSTRUCTION GENERAL AGGREGATE LIMIT ENDORSEMENT APPLICABLE TO EACH CONSTRUCTION PROJECT AS REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT. ACORD 707 (2008/01) O 2008 ACORD CORPORATION. All rigMs reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for "bodily injury" and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto" with your permission. However, this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a"trailer" connected to a covered "auto" you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto" owned by him or her or a member of his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "loss" which occurs prior to the date of your contract with such person or organization; 2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the leased or rented "auto" or the policy period ends, whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: 6115485 Transaction Effective Date:04-01-2021 COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. However, the insurance afforded to such This exclusion applies even if the claims additional insured: against any insured allege negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others 2. Will not be broader than that which you are by that insured, if the "occurrence" which required by the contract or agreement to caused the "bodily injury" or "property provide for such additional insured. damage", or the offense which caused the A person's or organization's status as an "personal and advertising injury", involved the additional insured under this endorsement ends rendering of or the failure to render any when your operations for that additional insured professional architectural, engineering or are completed. surveying services. O Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 33 12 19 Policy Number: 6115485 Transaction Effective Date: 04-01-2021 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 O Insurance Services Office, Inc., 2018 CG 20 33 12 19 Policy Number: 6115485 Transaction Effective Date: 04-01-2021 COMMERCIAL GENERAL LIABILITY CG24531219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. O Insurance Services Office, Inc., 2018 Page 1 of 1 CG 24 53 12 19 Policy Number: 6115485 Transaction Effective Date: 04-01-2021 POLICY NUMBER: 6115485 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Each construction project as required by written contract or written agreement. Information reauired to complete this Schedule. if not shown above. will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I- Coverage A, and for all medical expenses caused by accidents under Section I- Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". O Insurance Services Office, Inc., 2008 Page 1 of 2 CG 25 03 05 09 Policy Number: 6115485 Transaction Effective Date: 04-01-2021 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I- Coverage A, and for all medical expenses caused by accidents under Section I- Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: C«� When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. 1. Any payments made under Coverage A for damages or under Coverage C for medical D. expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. Page 2 of 2 CG 25 03 05 09 E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. O Insurance Services Office, Inc., 2008 Policy Number: 6115485 Transaction Effective Date: 04-01-2021