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Home My WebLink AboutL & M UNDERGROUND INC - INSURANCE CERTIFICATE 2023-2024DATE (MMIDDIYYYY) ACOR� CERTIFICATE OF LIABILITY INSURANCE �� 12/16/2022 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 CONTACT NAME: Rebecca Leatherman CRS Insurance Brokerage PHONE Fax 9780 S Meridian Blvd Suite 400 a�c r,o eXc : 303-996-7853 aic No : 303-757-7719 Englewood CO 80112 ADDR�ess: rleatherman crsdenver.com INSURER(S) AFFORDING COVERAGE NAIC # iNsuReRa: Westfield Insurance 24112 INSURED L&MUN-1 INSURER B: PIIlIlBCOI ASSUf81lC@ 41190 L & M Underground, Inc. 7529 S. Storm Mtn. iNsuReR c: Littleton CO 80127 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:429929639 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DDIYYYY MM/DDIYYYY A X COMMERCIALGENERALLIABILITY Y CMM4932062 1/1/2023 1/1/2024 EACHOCCURRENCE $1,OOQ000 DAMAGETO RENTED CLAIMS-MADE %� OCCUR PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $2,000,000 X POLICY � jE � � LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILELIABILITY Y CMM4932062 1/1/2023 1/1/2024 COMBINEDSINGLELIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLALIAB X OCCUR Y CMM4932062 1/1/2023 1/1/2024 EACHOCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION $ $ g WORKERSCOMPENSATION Y 4025271 1/1/2023 1/1/2024 X PER OTH- AND EMPLOYERS' LIABILITY Y� N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPER4TIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Leased/Rented Equipment CMM4932062 1/1/2023 1/1/2024 Limit 750,000 Deductible 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins and CDOT are included as additional insured for ongoing and completed operations on the General Liability and included as additional insured on the Auto Liability with respect to operations of the named insured for the certificate holder as required by written contract. Umbrella Liability follows form on the General Liability with respect to the additional insured. Workers Compensation coverage includes a waiver of subrogation. General Liability policy has been endorsed to provide (30) days notice of cancellation except 10-day notice for non-payment of premium. CERTIFICATE HOLDER CANCELLATION 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. Purchasing Division 215 North Mason Street, 2nd Floor P O BOX rJSO AUT�HORI��ZED REPRESENTATIVE Fort Collins CO 80522 � O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXPANDED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE The coverage provided by this endorsement is summarized below and is intended to provide a general coverage description only. For the details affecting each coverage, please refer to the terms and condi- tions in this endorsement. A. Who Is An Insured broadened: • Additional Insured by Contract, Agreement or Permit • Legaily Incorporated Subsidiaries . Newly Acquired Organizations B. Supplementary Payments • Bail Bonds - $5000 • Loss of Earnings - $500 C. Fellow Employee Exclusion Amendment D. Coverage Extensions • Transportation Expenses • Personal Effects (Excess Basis) E. Additional Coverages • Expenses paid for returning a stolen covered auto • Fire Department Service Charge F. Airbag Coverage - Accidental Discharge G, Glass Repair - Waiver of Deductible H. Knowledge and Notice of an Accident, Claim or Suit I. Unintentional Failure To Disclose Hazards J. Worldwide Coverage K. Definitions • Bodily lnjury Redefined In addition to the policy amendments contained in A. through K. listed above, the endorsements listed below will automatically be attached to your policy to complete the coverage provided by the Business Auto Expanded Endorsement: • Audio, Visual and Data Electronic Equipment Coverage Added Limits - CA 99 60 • Auto Loan/Lease Gap Coverage - CA 20 71 • Drive Other Car Coverage - Broadened Coverage For Named Individuals -(Executive Officers/Spouses) - CA 99 10 • Employee Hired Autos - CA 20 54 • Employees As Insureds - CA 99 33 • Hired Auto Physical Damage (Refer to Auto Declarations page) • Rental Reimbursement Coverage - CA 99 23 • Waiver of Transfer of Rights of Recovery (Waiver of Subrogation} - CA 04 44 A. WHO IS AN INSURED BROADENED SECTION II - COVERED AUTOS LIABILITY COVERAGE, item A. Coverage, 1, Who Is An Insured is amended to include the following additional paragraphs: d. Any legally incorporated subsidiary of yours in which you own more than 50% of the voting stock on the ef- fective date of this endorsement. However, "insured" does not include any subsidiary that is an "insured" under any other liability policy or would be an "insured" under such a policy but for its termination or the exhaustion of its limit of insurance. Coverage under this provision is af- forded only for the first 180 days af- ter you acquire or form the organization or until the end of the policy period, whichever comes first. e. Any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership or a majority in- terest. However, coverage under this provision: CA 70 78 10 13 Page 1 of 3 (1) Does not apply if the organiza- tion you acquire or form is an "insured" under another auto li- ability policy or would be "in- sured" under such a policy but for its termination or the ex- haustion of its limits of insur- ance; (2) Does not apply to "bodily injury" or "property damage" that oc- curred before you acquired or formed the organization; and (3) Is afforded only for the first 180 days after you acquire or form the organization or until the end of the policy period, whichever comes first. i. Any person or organization with whom you agreed in writing in a contract, agreement or permit, to provide insurance such as is af- forded under this policy. This provision only applies if the written contract or agreement has been executed or permit has been issued, prior to the "bodily injury" or "property damage". B. SUPPLEMENTAL PAYMENTS SECTION II - COVERED AUTOS LIABILITY GOVERAGE, item A. Cove�age, 2. Coverage Extensions, a. Supplementary Payments, sub- paragraphs {2) and (4) are deleted and re- placed with the following: (2) Up to $5,000 for cost of bail bonds (including bonds for re- lated traffic law violations) re- quired because of an "accidenY' we cover. We do not have to furnish these bonds. (4) All reasonable expenses in- curred by the "insured" at our request, including actual loss of earnings up to $500 per day be- cause of time off from work. C. FELLOW EMPLOYEE EXCLUSION AMEND- MENT � SECTtON II - COVERED AUTOS LIABILITY COVERAGE, item B. Exclusions, 5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. D. COVERAGE EXTENSIONS SECTION III - PHYSICAL DAMAGE COVER- AGE, Item A. Coverage, 4. Coverage Exten- sions, a. Transportation Expenses is replaced with the following: a, Transportation Expenses We will pay up to $100 per day to a maximum of $1,800 for transporta- tion expense incurred by you be- cause of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". The following is added to Item 4. Cover- age Extensions: c. Personal Effects We will pay up to $500 for the "loss" of your personal effects that are contained in a covered "auto" due to the total theft of the covered "auto." We will pay only for those personal effects that are contained in covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage. Our payment for "loss" of or damage to personal effects will apply only on an excess basis over other collect- ible insurance. E. ADDITIONAL COVERAGES SECTION III - PHYSICAL DAMAGE COVER- AGE, A. Coverage, is amended to include the following additional coverage items: 5. We will pay the expense of returning stolen covered "auto" to you. 6. Fire Department Service Charge When a fire department is called to save or protect a covered "auto", its equip- ment, its contents or occupants from a Covered Cause Of Loss, we will pay up to $1,000 for your liability for Fire De- partment Service Charges: (a) Assumed by contract or agreement prior to loss; or (b) Required by local ordinance. No deductible applies to this additional coverage. F. AIRBAG COVERAGE - ACCIDENTAL DIS- CHARGE SECTION III - PHYSICAL DAMAGE COVER- AGE, Item B. Exclusions, subparagraph 3.a. is deleted and replaced with the following: CA 70 78 10 13 Page 2 of 3 a. Wear and tear, freezing, mechanical I. or electrical breakdown. Mechanical breakdown does not apply to the ac- cidental discharge of an airbag. G. GLASS REPAIR - WAIVER OF DEDUCTIBLE SECTION III - PHYSICAL DAMAGE COVER- AGE, item D. Deductible the following para- graph is added: No deductible shall apply to glass dam- age if the glass is repaired rather than replaced. H. KNOWLEDGE AND NOTICE OF AN ACCI- DENT, CLAIM OR SUIT SECTION IV - BUSINESS AUTO CONDITIONS, Item A. Loss Conditions is amended as fol- lows: Subparagraph a. under Item 2. Duties In The Event Of Accident, Claim, Suit Or Loss, is amended to include the following paragraphs: This requirement applies when the "accident," claim, "suiY' or "loss" is first known to: (7) You, if you are an individual; {2) A partner, if you are a partner- ship; or (3) An executive officer or insur- ance manager, if you are a cor- poration. Subparagraph b.(2) under 2. Duties In The Event Of Accident, Claim, Suit Or Loss is amended as follows: (2) Immediately send us copies of any request, demand, order, notice, summons or legal paper received concerning the claim or "suit." Your employees may know of documents received concerning a claim or "suiY'. This will not mean that you have such know- ledge, unless receipt of such documents is known to you, any of your executive officers or partners or your insurance manager. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Under SECTION IV - BUSINESS AUTO CON- DITIONS, B. General Conditions, 2. Concealment, Misrepresentation Or Fraud is amended to include the following additional paragraph: If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. J. WORLDWIDE COVERAGE Under SECTION IV - BUSINESS AUTO CON- DITIONS, B. General Conditions, 7. Policy Period, Coverage Territory, subparagraph (5� is deleted and replaced with the following: (5j Anywhere in the world, if: (a) A covered "auto" of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 45 days or less; and (b) The "insured's" responsibility to pay damages is determined in a"suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. (c) If, for such "autos" a"suiY' is brought outside the territory de- scribed in 7.(1) through 7.(4) above, we will reimburse the insured for defense expenses incurred with our written con- sent, but we will make no pay- ment, nor will we reimburse the insured for damages. f�7�l:l�i[•I:� Under SECTION V- DEFINITIONS, Item C. is replaced by the following: C. "Bodily injury" means bodily injury, sick- ness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these. "Bodily injury" includes mental anguish or other mental injury resulting from "bodily injury". CA 70 78 10 13 Page 3 of 3 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations All persons or organizations when you have All Locations agreed in writing in a contract or agreement that such persons or organizations be added as an additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and adver- tising 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 oper- ations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent per- mitted by law; and 2. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following addi- tional exclusions apply: This insurance does not apply to "bodily in- jury" or "property damage" occurring after: 1. 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 addi- tional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or or- ganization 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: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1 2. Required by the contract or agreement; or Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the ap- plicable limits of insurance. o Insurance Services office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) And Description Of Covered Operations All persons or organizations when you have All Locations agreed in writing in a contract or agreement that such persons or organizations be added as an additional insured. nformation required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location desig- nated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent per- mitted by law; and 2. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1 2. Required by the contract or agreement; or Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the ap- plicable limits of insurance. O Insurance Services Office, Inc., 2018 CG 20 37 12 19 P1NN/1COL ASSURANCE L & M Underground Inc 7529 S. Storm Mtn Littleton, CO 80127 ENDORSEMENT: Blanket Waiver of Subrogation NCCI #: WC000313B Policy #: 4025271 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com CRS, Commercial Risk Solutions, Inc 9780 S Meridian Blvd Suite 400 Englewood, CO 80112 (303) 996-7800 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. Effective Date:January 1, 2023 Expires on: January 1, 2024 Pinnacol Assurance has issued this endorsement November 23, 2022 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P ROSSIGNB - Underwriter 11/23/2022 15:22:15 4025271 80712127 359-B DATE (MMIDDIYYYY) ACOR� CERTIFICATE OF LIABILITY INSURANCE �� 12/16/2022 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 CONTACT NAME: Rebecca Leatherman CRS Insurance Brokerage PHONE Fax 9780 S Meridian Blvd Suite 400 a�c r,o eXc : 303-996-7853 aic No : 303-757-7719 Englewood CO 80112 ADDR�ess: rleatherman crsdenver.com INSURER(S) AFFORDING COVERAGE NAIC # iNsuReRa: Westfield Insurance 24112 INSURED L&MUN-1 INSURER B: PIIlIlBCOI ASSUf81lC@ 41190 L & M Underground, Inc. 7529 S. Storm Mtn. iNsuReR c: Westchester Surplus Lines 10172 Littleton CO 80127 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1535699197 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DDIYYYY MM/DDIYYYY A X COMMERCIALGENERALLIABILITY Y CMM4932062 1/1/2023 1/1/2024 EACHOCCURRENCE $1,OOQ000 DAMAGETO RENTED CLAIMS-MADE %� OCCUR PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $2,000,000 X POLICY � jE � � LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILELIABILITY Y CMM4932062 1/1/2023 1/1/2024 COMBINEDSINGLELIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLALIAB X OCCUR Y CMM4932062 1/1/2023 1/1/2024 EACHOCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION $ $ g WORKERSCOMPENSATION Y 4025271 1/1/2023 1/1/2024 X PER OTH- AND EMPLOYERS' LIABILITY Y� N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPER4TIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Pollution Liability G27494456009 1/1/2023 1/1/2024 Limit 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: I-25 Electric Line Relocation Project City of Fort Collins and CDOT are included as additional insured for ongoing and completed operations on the General Liability and included as additional insured on the Auto Liability with respect to operations of the named insured for the certificate holder as required by written contract. Umbrella Liability follows form on the General Liability with respect to the additional insured. Workers Compensation coverage includes a waiver of subrogation. General Liability policy has been endorsed to provide (30) days notice of cancellation except 10-day notice for non-payment of premium. CERTIFICATE HOLDER CANCELLATION 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. Purchasing Division 215 North Mason Street, 2nd Floor P O BOX rJSO AUT�HORI��ZED REPRESENTATIVE Fort Collins CO 80522 � O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXPANDED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE The coverage provided by this endorsement is summarized below and is intended to provide a general coverage description only. For the details affecting each coverage, please refer to the terms and condi- tions in this endorsement. A. Who Is An Insured broadened: • Additional Insured by Contract, Agreement or Permit • Legaily Incorporated Subsidiaries . Newly Acquired Organizations B. Supplementary Payments • Bail Bonds - $5000 • Loss of Earnings - $500 C. Fellow Employee Exclusion Amendment D. Coverage Extensions • Transportation Expenses • Personal Effects (Excess Basis) E. Additional Coverages • Expenses paid for returning a stolen covered auto • Fire Department Service Charge F. Airbag Coverage - Accidental Discharge G, Glass Repair - Waiver of Deductible H. Knowledge and Notice of an Accident, Claim or Suit I. Unintentional Failure To Disclose Hazards J. Worldwide Coverage K. Definitions • Bodily lnjury Redefined In addition to the policy amendments contained in A. through K. listed above, the endorsements listed below will automatically be attached to your policy to complete the coverage provided by the Business Auto Expanded Endorsement: • Audio, Visual and Data Electronic Equipment Coverage Added Limits - CA 99 60 • Auto Loan/Lease Gap Coverage - CA 20 71 • Drive Other Car Coverage - Broadened Coverage For Named Individuals -(Executive Officers/Spouses) - CA 99 10 • Employee Hired Autos - CA 20 54 • Employees As Insureds - CA 99 33 • Hired Auto Physical Damage (Refer to Auto Declarations page) • Rental Reimbursement Coverage - CA 99 23 • Waiver of Transfer of Rights of Recovery (Waiver of Subrogation} - CA 04 44 A. WHO IS AN INSURED BROADENED SECTION II - COVERED AUTOS LIABILITY COVERAGE, item A. Coverage, 1, Who Is An Insured is amended to include the following additional paragraphs: d. Any legally incorporated subsidiary of yours in which you own more than 50% of the voting stock on the ef- fective date of this endorsement. However, "insured" does not include any subsidiary that is an "insured" under any other liability policy or would be an "insured" under such a policy but for its termination or the exhaustion of its limit of insurance. Coverage under this provision is af- forded only for the first 180 days af- ter you acquire or form the organization or until the end of the policy period, whichever comes first. e. Any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership or a majority in- terest. However, coverage under this provision: CA 70 78 10 13 Page 1 of 3 (1) Does not apply if the organiza- tion you acquire or form is an "insured" under another auto li- ability policy or would be "in- sured" under such a policy but for its termination or the ex- haustion of its limits of insur- ance; (2) Does not apply to "bodily injury" or "property damage" that oc- curred before you acquired or formed the organization; and (3) Is afforded only for the first 180 days after you acquire or form the organization or until the end of the policy period, whichever comes first. i. Any person or organization with whom you agreed in writing in a contract, agreement or permit, to provide insurance such as is af- forded under this policy. This provision only applies if the written contract or agreement has been executed or permit has been issued, prior to the "bodily injury" or "property damage". B. SUPPLEMENTAL PAYMENTS SECTION II - COVERED AUTOS LIABILITY GOVERAGE, item A. Cove�age, 2. Coverage Extensions, a. Supplementary Payments, sub- paragraphs {2) and (4) are deleted and re- placed with the following: (2) Up to $5,000 for cost of bail bonds (including bonds for re- lated traffic law violations) re- quired because of an "accidenY' we cover. We do not have to furnish these bonds. (4) All reasonable expenses in- curred by the "insured" at our request, including actual loss of earnings up to $500 per day be- cause of time off from work. C. FELLOW EMPLOYEE EXCLUSION AMEND- MENT � SECTtON II - COVERED AUTOS LIABILITY COVERAGE, item B. Exclusions, 5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. D. COVERAGE EXTENSIONS SECTION III - PHYSICAL DAMAGE COVER- AGE, Item A. Coverage, 4. Coverage Exten- sions, a. Transportation Expenses is replaced with the following: a, Transportation Expenses We will pay up to $100 per day to a maximum of $1,800 for transporta- tion expense incurred by you be- cause of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". The following is added to Item 4. Cover- age Extensions: c. Personal Effects We will pay up to $500 for the "loss" of your personal effects that are contained in a covered "auto" due to the total theft of the covered "auto." We will pay only for those personal effects that are contained in covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage. Our payment for "loss" of or damage to personal effects will apply only on an excess basis over other collect- ible insurance. E. ADDITIONAL COVERAGES SECTION III - PHYSICAL DAMAGE COVER- AGE, A. Coverage, is amended to include the following additional coverage items: 5. We will pay the expense of returning stolen covered "auto" to you. 6. Fire Department Service Charge When a fire department is called to save or protect a covered "auto", its equip- ment, its contents or occupants from a Covered Cause Of Loss, we will pay up to $1,000 for your liability for Fire De- partment Service Charges: (a) Assumed by contract or agreement prior to loss; or (b) Required by local ordinance. No deductible applies to this additional coverage. F. AIRBAG COVERAGE - ACCIDENTAL DIS- CHARGE SECTION III - PHYSICAL DAMAGE COVER- AGE, Item B. Exclusions, subparagraph 3.a. is deleted and replaced with the following: CA 70 78 10 13 Page 2 of 3 a. Wear and tear, freezing, mechanical I. or electrical breakdown. Mechanical breakdown does not apply to the ac- cidental discharge of an airbag. G. GLASS REPAIR - WAIVER OF DEDUCTIBLE SECTION III - PHYSICAL DAMAGE COVER- AGE, item D. Deductible the following para- graph is added: No deductible shall apply to glass dam- age if the glass is repaired rather than replaced. H. KNOWLEDGE AND NOTICE OF AN ACCI- DENT, CLAIM OR SUIT SECTION IV - BUSINESS AUTO CONDITIONS, Item A. Loss Conditions is amended as fol- lows: Subparagraph a. under Item 2. Duties In The Event Of Accident, Claim, Suit Or Loss, is amended to include the following paragraphs: This requirement applies when the "accident," claim, "suiY' or "loss" is first known to: (7) You, if you are an individual; {2) A partner, if you are a partner- ship; or (3) An executive officer or insur- ance manager, if you are a cor- poration. Subparagraph b.(2) under 2. Duties In The Event Of Accident, Claim, Suit Or Loss is amended as follows: (2) Immediately send us copies of any request, demand, order, notice, summons or legal paper received concerning the claim or "suit." Your employees may know of documents received concerning a claim or "suiY'. This will not mean that you have such know- ledge, unless receipt of such documents is known to you, any of your executive officers or partners or your insurance manager. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Under SECTION IV - BUSINESS AUTO CON- DITIONS, B. General Conditions, 2. Concealment, Misrepresentation Or Fraud is amended to include the following additional paragraph: If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. J. WORLDWIDE COVERAGE Under SECTION IV - BUSINESS AUTO CON- DITIONS, B. General Conditions, 7. Policy Period, Coverage Territory, subparagraph (5� is deleted and replaced with the following: (5j Anywhere in the world, if: (a) A covered "auto" of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 45 days or less; and (b) The "insured's" responsibility to pay damages is determined in a"suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. (c) If, for such "autos" a"suiY' is brought outside the territory de- scribed in 7.(1) through 7.(4) above, we will reimburse the insured for defense expenses incurred with our written con- sent, but we will make no pay- ment, nor will we reimburse the insured for damages. f�7�l:l�i[•I:� Under SECTION V- DEFINITIONS, Item C. is replaced by the following: C. "Bodily injury" means bodily injury, sick- ness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these. "Bodily injury" includes mental anguish or other mental injury resulting from "bodily injury". CA 70 78 10 13 Page 3 of 3 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations All persons or organizations when you have All Locations agreed in writing in a contract or agreement that such persons or organizations be added as an additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and adver- tising 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 oper- ations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent per- mitted by law; and 2. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following addi- tional exclusions apply: This insurance does not apply to "bodily in- jury" or "property damage" occurring after: 1. 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 addi- tional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or or- ganization 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: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1 2. Required by the contract or agreement; or Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the ap- plicable limits of insurance. o Insurance Services office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) And Description Of Covered Operations All persons or organizations when you have All Locations agreed in writing in a contract or agreement that such persons or organizations be added as an additional insured. nformation required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location desig- nated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent per- mitted by law; and 2. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1 2. Required by the contract or agreement; or Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the ap- plicable limits of insurance. O Insurance Services Office, Inc., 2018 CG 20 37 12 19 P1NN/1COL ASSURANCE L & M Underground Inc 7529 S. Storm Mtn Littleton, CO 80127 ENDORSEMENT: Blanket Waiver of Subrogation NCCI #: WC000313B Policy #: 4025271 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com CRS, Commercial Risk Solutions, Inc 9780 S Meridian Blvd Suite 400 Englewood, CO 80112 (303) 996-7800 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. Effective Date:January 1, 2023 Expires on: January 1, 2024 Pinnacol Assurance has issued this endorsement November 23, 2022 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P ROSSIGNB - Underwriter 11/23/2022 15:22:15 4025271 80712127 359-B DATE (MMIDDIYYYY) ACOR� CERTIFICATE OF LIABILITY INSURANCE �� 12/16/2022 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 CONTACT NAME: Rebecca Leatherman CRS Insurance Brokerage PHONE Fax 9780 S Meridian Blvd Suite 400 a�c r,o eXc : 303-996-7853 aic No : 303-757-7719 Englewood CO 80112 ADDR�ess: rleatherman crsdenver.com INSURER(S) AFFORDING COVERAGE NAIC # iNsuReRa: Westfield Insurance 24112 INSURED L&MUN-1 INSURER B: PIIlIlBCOI ASSUf81lC@ 41190 L & M Underground, Inc. 7529 S. Storm Mtn. iNsuReR c: Littleton CO 80127 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1986494788 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DDIYYYY MM/DDIYYYY A X COMMERCIALGENERALLIABILITY Y CMM4932062 1/1/2023 1/1/2024 EACHOCCURRENCE $1,OOQ000 DAMAGETO RENTED CLAIMS-MADE %� OCCUR PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $2,000,000 X POLICY � jE � � LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILELIABILITY Y CMM4932062 1/1/2023 1/1/2024 COMBINEDSINGLELIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLALIAB X OCCUR Y CMM4932062 1/1/2023 1/1/2024 EACHOCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION $ $ g WORKERSCOMPENSATION Y 4025271 1/1/2023 1/1/2024 X PER OTH- AND EMPLOYERS' LIABILITY Y� N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPER4TIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Leased/Rented Equipment CMM4932062 1/1/2023 1/1/2024 Limit 750,000 Deductible 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: I-25 Electric Line Relocation Project City of Fort Collins and CDOT are included as additional insured for ongoing and completed operations on the General Liability and included as additional insured on the Auto Liability with respect to operations of the named insured for the certificate holder as required by written contract. Umbrella Liability follows form on the General Liability with respect to the additional insured. Workers Compensation coverage includes a waiver of subrogation. General Liability policy has been endorsed to provide (30) days notice of cancellation except 10-day notice for non-payment of premium. CERTIFICATE HOLDER CANCELLATION 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. Purchasing Division 215 North Mason Street, 2nd Floor P O BOX rJSO AUT�HORI��ZED REPRESENTATIVE Fort Collins CO 80522 � O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXPANDED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE The coverage provided by this endorsement is summarized below and is intended to provide a general coverage description only. For the details affecting each coverage, please refer to the terms and condi- tions in this endorsement. A. Who Is An Insured broadened: • Additional Insured by Contract, Agreement or Permit • Legaily Incorporated Subsidiaries . Newly Acquired Organizations B. Supplementary Payments • Bail Bonds - $5000 • Loss of Earnings - $500 C. Fellow Employee Exclusion Amendment D. Coverage Extensions • Transportation Expenses • Personal Effects (Excess Basis) E. Additional Coverages • Expenses paid for returning a stolen covered auto • Fire Department Service Charge F. Airbag Coverage - Accidental Discharge G, Glass Repair - Waiver of Deductible H. Knowledge and Notice of an Accident, Claim or Suit I. Unintentional Failure To Disclose Hazards J. Worldwide Coverage K. Definitions • Bodily lnjury Redefined In addition to the policy amendments contained in A. through K. listed above, the endorsements listed below will automatically be attached to your policy to complete the coverage provided by the Business Auto Expanded Endorsement: • Audio, Visual and Data Electronic Equipment Coverage Added Limits - CA 99 60 • Auto Loan/Lease Gap Coverage - CA 20 71 • Drive Other Car Coverage - Broadened Coverage For Named Individuals -(Executive Officers/Spouses) - CA 99 10 • Employee Hired Autos - CA 20 54 • Employees As Insureds - CA 99 33 • Hired Auto Physical Damage (Refer to Auto Declarations page) • Rental Reimbursement Coverage - CA 99 23 • Waiver of Transfer of Rights of Recovery (Waiver of Subrogation} - CA 04 44 A. WHO IS AN INSURED BROADENED SECTION II - COVERED AUTOS LIABILITY COVERAGE, item A. Coverage, 1, Who Is An Insured is amended to include the following additional paragraphs: d. Any legally incorporated subsidiary of yours in which you own more than 50% of the voting stock on the ef- fective date of this endorsement. However, "insured" does not include any subsidiary that is an "insured" under any other liability policy or would be an "insured" under such a policy but for its termination or the exhaustion of its limit of insurance. Coverage under this provision is af- forded only for the first 180 days af- ter you acquire or form the organization or until the end of the policy period, whichever comes first. e. Any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership or a majority in- terest. However, coverage under this provision: CA 70 78 10 13 Page 1 of 3 (1) Does not apply if the organiza- tion you acquire or form is an "insured" under another auto li- ability policy or would be "in- sured" under such a policy but for its termination or the ex- haustion of its limits of insur- ance; (2) Does not apply to "bodily injury" or "property damage" that oc- curred before you acquired or formed the organization; and (3) Is afforded only for the first 180 days after you acquire or form the organization or until the end of the policy period, whichever comes first. i. Any person or organization with whom you agreed in writing in a contract, agreement or permit, to provide insurance such as is af- forded under this policy. This provision only applies if the written contract or agreement has been executed or permit has been issued, prior to the "bodily injury" or "property damage". B. SUPPLEMENTAL PAYMENTS SECTION II - COVERED AUTOS LIABILITY GOVERAGE, item A. Cove�age, 2. Coverage Extensions, a. Supplementary Payments, sub- paragraphs {2) and (4) are deleted and re- placed with the following: (2) Up to $5,000 for cost of bail bonds (including bonds for re- lated traffic law violations) re- quired because of an "accidenY' we cover. We do not have to furnish these bonds. (4) All reasonable expenses in- curred by the "insured" at our request, including actual loss of earnings up to $500 per day be- cause of time off from work. C. FELLOW EMPLOYEE EXCLUSION AMEND- MENT � SECTtON II - COVERED AUTOS LIABILITY COVERAGE, item B. Exclusions, 5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. D. COVERAGE EXTENSIONS SECTION III - PHYSICAL DAMAGE COVER- AGE, Item A. Coverage, 4. Coverage Exten- sions, a. Transportation Expenses is replaced with the following: a, Transportation Expenses We will pay up to $100 per day to a maximum of $1,800 for transporta- tion expense incurred by you be- cause of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". The following is added to Item 4. Cover- age Extensions: c. Personal Effects We will pay up to $500 for the "loss" of your personal effects that are contained in a covered "auto" due to the total theft of the covered "auto." We will pay only for those personal effects that are contained in covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage. Our payment for "loss" of or damage to personal effects will apply only on an excess basis over other collect- ible insurance. E. ADDITIONAL COVERAGES SECTION III - PHYSICAL DAMAGE COVER- AGE, A. Coverage, is amended to include the following additional coverage items: 5. We will pay the expense of returning stolen covered "auto" to you. 6. Fire Department Service Charge When a fire department is called to save or protect a covered "auto", its equip- ment, its contents or occupants from a Covered Cause Of Loss, we will pay up to $1,000 for your liability for Fire De- partment Service Charges: (a) Assumed by contract or agreement prior to loss; or (b) Required by local ordinance. No deductible applies to this additional coverage. F. AIRBAG COVERAGE - ACCIDENTAL DIS- CHARGE SECTION III - PHYSICAL DAMAGE COVER- AGE, Item B. Exclusions, subparagraph 3.a. is deleted and replaced with the following: CA 70 78 10 13 Page 2 of 3 a. Wear and tear, freezing, mechanical I. or electrical breakdown. Mechanical breakdown does not apply to the ac- cidental discharge of an airbag. G. GLASS REPAIR - WAIVER OF DEDUCTIBLE SECTION III - PHYSICAL DAMAGE COVER- AGE, item D. Deductible the following para- graph is added: No deductible shall apply to glass dam- age if the glass is repaired rather than replaced. H. KNOWLEDGE AND NOTICE OF AN ACCI- DENT, CLAIM OR SUIT SECTION IV - BUSINESS AUTO CONDITIONS, Item A. Loss Conditions is amended as fol- lows: Subparagraph a. under Item 2. Duties In The Event Of Accident, Claim, Suit Or Loss, is amended to include the following paragraphs: This requirement applies when the "accident," claim, "suiY' or "loss" is first known to: (7) You, if you are an individual; {2) A partner, if you are a partner- ship; or (3) An executive officer or insur- ance manager, if you are a cor- poration. Subparagraph b.(2) under 2. Duties In The Event Of Accident, Claim, Suit Or Loss is amended as follows: (2) Immediately send us copies of any request, demand, order, notice, summons or legal paper received concerning the claim or "suit." Your employees may know of documents received concerning a claim or "suiY'. This will not mean that you have such know- ledge, unless receipt of such documents is known to you, any of your executive officers or partners or your insurance manager. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Under SECTION IV - BUSINESS AUTO CON- DITIONS, B. General Conditions, 2. Concealment, Misrepresentation Or Fraud is amended to include the following additional paragraph: If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. J. WORLDWIDE COVERAGE Under SECTION IV - BUSINESS AUTO CON- DITIONS, B. General Conditions, 7. Policy Period, Coverage Territory, subparagraph (5� is deleted and replaced with the following: (5j Anywhere in the world, if: (a) A covered "auto" of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 45 days or less; and (b) The "insured's" responsibility to pay damages is determined in a"suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. (c) If, for such "autos" a"suiY' is brought outside the territory de- scribed in 7.(1) through 7.(4) above, we will reimburse the insured for defense expenses incurred with our written con- sent, but we will make no pay- ment, nor will we reimburse the insured for damages. f�7�l:l�i[•I:� Under SECTION V- DEFINITIONS, Item C. is replaced by the following: C. "Bodily injury" means bodily injury, sick- ness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these. "Bodily injury" includes mental anguish or other mental injury resulting from "bodily injury". CA 70 78 10 13 Page 3 of 3 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations All persons or organizations when you have All Locations agreed in writing in a contract or agreement that such persons or organizations be added as an additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and adver- tising 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 oper- ations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent per- mitted by law; and 2. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following addi- tional exclusions apply: This insurance does not apply to "bodily in- jury" or "property damage" occurring after: 1. 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 addi- tional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or or- ganization 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: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1 2. Required by the contract or agreement; or Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the ap- plicable limits of insurance. o Insurance Services office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) And Description Of Covered Operations All persons or organizations when you have All Locations agreed in writing in a contract or agreement that such persons or organizations be added as an additional insured. nformation required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location desig- nated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent per- mitted by law; and 2. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1 2. Required by the contract or agreement; or Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the ap- plicable limits of insurance. O Insurance Services Office, Inc., 2018 CG 20 37 12 19 P1NN/1COL ASSURANCE L & M Underground Inc 7529 S. Storm Mtn Littleton, CO 80127 ENDORSEMENT: Blanket Waiver of Subrogation NCCI #: WC000313B Policy #: 4025271 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com CRS, Commercial Risk Solutions, Inc 9780 S Meridian Blvd Suite 400 Englewood, CO 80112 (303) 996-7800 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. Effective Date:January 1, 2023 Expires on: January 1, 2024 Pinnacol Assurance has issued this endorsement November 23, 2022 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P ROSSIGNB - Underwriter 11/23/2022 15:22:15 4025271 80712127 359-B