HomeMy WebLinkAboutROCKY MOUNTAIN COATINGS - INSURANCE CERTIFICATEDATE (MM/DD/YYYY)
A`� �� CERTIFICATE OF LIABILITY INSURANCE �iRiZo24
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 Connor Pierce
NAME:
Evertree Insurance LLC PHONE 303 431-9351
A/C, No, Ext : � ) (FUC, No):
5440 Ward Road, Suite 215 qooRESS: agency cU 1 aia.com
INSURER(S) AFFORDING COVERAGE NAIC #
Arvada CO 80002 wsuRER A: LJNITED FIRE & CAS CO 13021
INSURED
ROCKY MOUN7'AIN COATINGS KINTZLEY DENNIS UBA
737 KNOLLWOOD C1R
FORT COLL[NS
CO 80524-I585
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 4.8.24
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.
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ I,OOO,OOO
CLAIMS-MADE � OCCUR PREMISES (Ea occurrence) $ 100,000
MED EXP (Any one person) $ 5,��0
A Y 60430252 04/04/2024 04/04/2025 PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY � jE � � LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000
ANY AUTO BODILY INJURY (Per person) $
A OWNED y SCHEDULED Y 60430252 04/04/2024 04/04/2025 BODILY INJURY (Per accident) $
AUTOS ONLY I\ AUTOS
XHIRED y NON-OWNED $
AUTOS ONLY ^ AUTOS ONLY (Per accident)
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
ORKERS COMPENSATION -
ND EMPLOYERS' LIABILITY Y� N STATUTE ER
NY PROPRIETOR/PARTNER/EXECUTIVE ❑ N� A E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCWDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Fort Collins is included as Additional Insured ou tlie General Liability and Commcrcial Auto policies, where a written contract exists, per the terms of attached blanket
endorsement and Commercial Auto Additional Insured Scl�edule.
City of Fort Collins
Purchasing Dept
PO BOx 580
Fort Collins CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEILED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
f.n••+M' PiRru
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
CG 70 87 07 17
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -
AUTOMATIC STATUS FOR OTHER PARTIES 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
a. 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.
b. Any other person or organization you are required to add as an additional insured under the contract or
agreement described in Paragraph a. above.
Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury" which may be imputed to that person or organization directly arising
out of:
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.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law; and
2. Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured
A person's or organization's status as an insured under this endorsement ends when your operations for that
insured at that location are completed.
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.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the
"bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the
rendering of or the failure to render any professional architectural, engineering or surveying services.
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.
CG 70 87 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2
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 shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
CG 70 87 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2
0104 04-04-2024
POLICY NUMBER: 6 0 4 3 0 2 5 2
SUPPLEMENTAL DECLARATIONS - ADDITIONAL INSUREDS
CA 71 16 01 07
0104 04-04-2024
POLICY NUMBER: 6043 0 25 2
FORMS SUPPLEMENTAL DECLARATIONS
The following coverage form(s) govern coverage that is not limited to any
specific state even though they are specifically listed in only one state in
the declarations.
Other Forms
Applicable to the
CA0001 (11-20)
CA0113 (10-13)
CA0440 (10-13)
CA0449 (11-16)
CA2150 (07-17)
CA2345 (11-20)
CA2394(10-13)
*CA7039 (12-21)
*CA7040 (03-93)
*CA7041 (03-23)
�CA7116 (O1-07)
CA7130 (05-10)
CA7358 (03-19)
CA9917 (10-13)
IL0017 (11-98)
IL0021 (09-08)
IL0125 (11-13)
IL0169 (09-07)
IL0228 (09-07)
IL7009- (04-91)
IL7068 (O1-10)
IL7069 (01-10)
IL7070 (09-12)
IL7083 (08-10)
IL7177 (08-22)
*ST0012 (01-08)
*ST0015 (03-09)
*ST1644- (01-12)
*ST1882 (06-16)
*ST2003 (11-21)
state of Colorado
BUSINESS AUTO COVG FORM
CO-CHGS
CO-AUTO MED PAYMENTS COVG
PRIMARY & NONCONTRIBUTORY OTHER INSURANCE
CO-UM BI COVG
PUBLIC/LIVERY PASSENGER CONVEYANCE & ON DEMAND DEL
SILICA/SILICA-RELATED DUST EXCL FOR COVERED AUTOS
COMM AUTO COVG PART SCHEDULE OF COVERED AUTOS
SUPPLEMENTAL DECS
COMM AUTO COVG PART
CA ADDITIONAL INSURED SUPPLEMENTAL DEC
ADDL INSURED/INTEREST END
MULTIPLE LIAB COVG LIMITATION
INDIVIDUAL NAMED INSURED
COMMON POLICY CONDITIONS
NUCLEAR ENERGY LIAB EXCL
CO-CHGS-CIVIL UNIONS
CO-CHGS CONCEALMENT MISREPRESENTATION/FRAUD
CO-CHGS CANCEL & NONRENEW
AMENDATORY END PUNITIVE/EXEMPLARY DAMAGES EXCL
EXCL-LEAD-HAZARDOUS PROPERTIES
EXCL-UNDERGROUND STORAGE TANKS
ABSOLUTE ASBESTOS EXCL
PAYMENT OF LOSSES
ABSOLUTE PFAS EXCLUSION
CO-NOTICE UM-UIM OFFERING
CO-MED PAY COVG
POLICY WEBSITE STUFFER
NOTICE-LOCATION & PREMISES CLARIFICATION
NOTICE OF PREM AUDIT NONCOMPLIANCE CHARGE
UW 70 02 04 96