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HomeMy WebLinkAboutSEMA CONSTRUCTION INC - INSURANCE CERTIFICATE 2023-2024SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY hvencil@holmesmurphy.com X 19489 22837 19984 Fort Collins, CO 80522 35289 5,000 12300 1,000,000 hvencilwdsm 10,000,000 2,500,000 06/01/24 06/01/24 WCA000028523 WCA000028423 WCA000028323 X A GL23A00089 A GL23B00089 1-800-247-7756 A GL23C00089 10,000,000 X 10,000,000 06/01/23 06/01/23 06/01/23 Holmes Murphy & Associates - WDM X X Purchasing Division City of Fort Collins 10,000,000 03122848 MZI93082892 SEMA Construction, Inc. C C C 68862919 68862919 5,000,000 10,000,000 E D 06/01/24 06/01/24 ALLIED WORLD ASSUR CO US INC 06/01/24 AGCS MARINE INS CO ACIG INS CO CONTINENTAL INS CO AMERICAN CONTRACTORS INS CO RRG PO Box 9207 10,000,000 06/01/23 06/01/23 06/01/23 06/01/24 06/01/24 X Des Moines, IA 50306-9207 06/01/24 A Each Occurrence 100,000 Limit 06/01/24 Centennial, CO 80112 Excess Liability USA 1,000,000 Leased/Rented Equipment 06/01/24 PO Box 580 AL23000035 X Heather Vencil 06/01/23 06/01/23 06/01/23 7353 S Eagle Street 10,000,000 X N 06/01/23 1,000,000 X B X X thirty (30) days written notice has been received by the City of Fort Collins. The insurance evidenced by this Certificate will not reduce coverage or limits and will not be cancelled, except after CUE7033727217 Liability when required by written contract or agreement, per policy terms & conditions. 05/31/2023 The City, its officers, agents and employees are included as Additional Insureds on the Auto Liability and General RE: Ft.Collins - CMGC LaPorte Ave.-PreConst Srvcs; Project No. 9509 CM/GC; Sema #102206 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY hvencil@holmesmurphy.com X 19489 22837 19984 Fort Collins, CO 80522 35289 5,000 12300 1,000,000 hvencilwdsm 10,000,000 2,500,000 06/01/24 06/01/24 WCA000028523 WCA000028423 WCA000028323 X A GL23A00089 A GL23B00089 1-800-247-7756 A GL23C00089 10,000,000 X 10,000,000 06/01/23 06/01/23 06/01/23 Holmes Murphy & Associates - WDM X X Purchasing Division City of Fort Collins 10,000,000 03122848 MZI93082892 SEMA Construction, Inc. C C C 68862933 68862933 5,000,000 10,000,000 E D 06/01/24 06/01/24 ALLIED WORLD ASSUR CO US INC 06/01/24 AGCS MARINE INS CO ACIG INS CO CONTINENTAL INS CO AMERICAN CONTRACTORS INS CO RRG PO Box 9207 10,000,000 06/01/23 06/01/23 06/01/23 06/01/24 06/01/24 X Des Moines, IA 50306-9207 06/01/24 A Each Occurrence 100,000 Limit 06/01/24 Centennial, CO 80112 Excess Liability USA 1,000,000 Leased/Rented Equipment 06/01/24 PO Box 580 AL23000035 X Heather Vencil 06/01/23 06/01/23 06/01/23 7353 S Eagle Street 10,000,000 X N 06/01/23 1,000,000 X B X X thirty (30) days written notice has been received by the City of Fort Collins. The insurance evidenced by this Certificate will not reduce coverage or limits and will not be cancelled, except after CUE7033727217 Liability when required by written contract or agreement, per policy terms & conditions. 05/31/2023 The City, its officers, agents and employees are included as Additional Insureds on the Auto Liability and General Re: Fort Collins Construction Package CP-1 / W.O. #2; Project No. 9509; SEMA Job #102220 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY hvencil@holmesmurphy.com X 19489 22837 19984 Fort Collins, CO 80522 35289 5,000 12300 1,000,000 hvencilwdsm 10,000,000 2,500,000 06/01/24 06/01/24 WCA000028523 WCA000028423 WCA000028323 X A GL23A00089 A GL23B00089 1-800-247-7756 A GL23C00089 10,000,000 X 10,000,000 06/01/23 06/01/23 06/01/23 Holmes Murphy & Associates - WDM X X Purchasing Division City of Fort Collins 10,000,000 03122848 MZI93082892 SEMA Construction, Inc. C C C 68862936 68862936 5,000,000 10,000,000 E D 06/01/24 06/01/24 ALLIED WORLD ASSUR CO US INC 06/01/24 AGCS MARINE INS CO ACIG INS CO CONTINENTAL INS CO AMERICAN CONTRACTORS INS CO RRG PO Box 9207 10,000,000 06/01/23 06/01/23 06/01/23 06/01/24 06/01/24 X Des Moines, IA 50306-9207 06/01/24 A Each Occurrence 100,000 Limit 06/01/24 Centennial, CO 80112 Excess Liability USA 1,000,000 Leased/Rented Equipment 06/01/24 PO Box 580 AL23000035 X Heather Vencil 06/01/23 06/01/23 06/01/23 7353 S Eagle Street 10,000,000 X N 06/01/23 1,000,000 X B X X thirty (30) days written notice has been received by the City of Fort Collins. The insurance evidenced by this Certificate will not reduce coverage or limits and will not be cancelled, except after CUE7033727217 Liability when required by written contract or agreement, per policy terms & conditions. 05/31/2023 The City, its officers, agents and employees are included as Additional Insureds on the Auto Liability and General Project # 9509 LaPorter Ave. / CP-1 / WO #3 SEMA Job #: 102220 - WO#3                          !"   #  $    % %$$$$"  $        & ##   '            $ (  (    & (  & ) $     *&    #  $          # # $  #   )          ( +,      ## $   ) $   - '       ) ## ($   ( +,    #         ( +    )    "-        -       , ) $   & .#' %- "& %- - / "&  (  #    ) %  % #  ) # %    $ #                                                                                                                                          0  1   2 2! 2 123! 4   56 5778%95" : 988;.5778   ,  20 ! 2!2<,    $ #  ( (  (   ( #  '     #-  + (      +  $   , Holmes Murphy & Associates - WDM MZI93082892 100,000 100,000 100,000 06/01/24 USA AGCS MARINE INS CO 7353 S Eagle Street hvencilwdsm SEMA Construction, Inc. PO Box 9207 Des Moines, IA 50306-9207 Heather Vencil Centennial, CO 80112 Fort Collins, CO 80522 PO Box 580 Builder's Risk (Bridges) Builder's Risk (Dams) Builder's Risk (All Construction Types Except Dams & Bridges) 06/01/23 68862967 Purchasing Division City of Fort Collins hvencil@holmesmurphy. 05/31/2023 1-800-247-7756 Contract amount $3,963,255.65 Project # 9509 LaPorter Ave. / CP-1 / WO #3 SEMA Job #: 102220 - WO#3 10,000,000 2,000,000 30,000,000