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HomeMy WebLinkAboutL & M Underground Inc - Insurance Certificate 2025 ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `� 1 12/30/2024 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: Jesse Hull CRS Insurance Brokerage PHONE FAX 9780 S Meridian Blvd Suite 400 ,Mc No E : 303-996-7800 A/c No:303-757-7719 Englewood CO 80112 ADD RESS: jhull@crsdenver.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Westfield Insurance 24112 INSURED L&MUN-1 INSURER B:Plnnacol Assurance 41190 L& M Underground, Inc. 7529 S. Storm Mtn. INSURERC:Indian Harbor Insurance 36940 Littleton CO 80127 INSURER D r CNA 20478 INSURER E r INSURER F: COVERAGES CERTIFICATE NUMBER:1831382869 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 ADDLSUBRTYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LTR MMIDDNYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y CMM4932062 1/1/2025 1/1/2026 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X . OCCUR DAMAGES(E c rr PREMISES Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN X 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y CMM4932062 1/1/2025 1/1/2026 COMBINED SINGLE LIMIT $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 UMBRELLA LIAB X OCCUR Y CMM4932062 1/1/2025 1/1/2026 EACH OCCURRENCE $5,000,000 D 7095230166 1/1/2025 1/1/2026 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED I X I RETENTION$n Excess Liability $5,000,000 B WORKERS COMPENSATION Y 4025271 1/1/2025 1/1/2026 X PER T - AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED? N I N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability PECO064834 1/1/2025 1/1/2026 Limit 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: 1-25 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 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522 - ©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 • Legally 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 Injury 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 policy but for its termination or the SECTION II - COVERED AUTOS LIABILITY exhaustion of its limit of insurance. COVERAGE, item A. Coverage, 1. Who Is An Coverage under this provision is af- Insured is amended to include the following forded only for the first 180 days af- additional paragraphs: ter you acquire or form the d. Any legally incorporated subsidiary organization or until the end of the of yours in which you own more than policy period, whichever comes first. 50% of the voting stock on the ef- e. Any organization you newly acquire fective date of this endorsement. or form, other than a partnership or However, "insured" does not include joint venture, and over which you any subsidiary that is an "insured" maintain ownership or a majority in- under any other liability policy or terest. However, coverage under would be an "insured" under such a this provision: CA 70 78 10 13 Page 1 of 3 (1) Does not apply if the organiza- a. Transportation Expenses tion you acquire or form is an We will pay up to $100 per day to a "insured" under another auto li- maximum of $1,800 for transporta- ability policy or would be "in- sured" under such a policy but tion expense incurred by you be- ts termination or the ex- cause of the total theft of a covered for its tion of its limits of ins - "auto" of the private passenger type. ance; We will pay only for those covered "autos" for which you carry either (2) Does not apply to "bodily injury" Comprehensive or Specified Causes or "property damage" that oc- of Loss Coverage. We will pay for curred before you acquired or transportation expenses incurred formed the organization; and during the period beginning 48 hours after the theft and ending, regardless (3) Is afforded only for the first 180 of the policy's expiration, when the days after you acquire or form covered "auto" is returned to use or the organization or until the end we pay for its "loss". of the policy period, whichever Cover- comes first. The following is added to Item 4. Cover- age Extensions: f. Any person or organization with c. Personal Effects whom you agreed in writing in a contract, agreement or permit, to We will pay up to $500 for the "loss" provide insurance such as is af- of your personal effects that are forded under this policy. contained in a covered "auto" due to the total theft of the covered "auto." This provision only applies if the We will pay only for those personal written contract or agreement has effects that are contained in covered been executed or permit has been "autos" for which you carry either issued, prior to the "bodily injury" or Comprehensive or Specified Causes "property damage". Of Loss Coverage. B. SUPPLEMENTAL PAYMENTS Our payment for"loss" of or damage to personal effects will apply only on SECTION 11 - COVERED AUTOS LIABILITY an excess basis over other collect- COVERAGE, item A. Coverage, 2. Coverage ible insurance. Extensions, a. Supplementary Payments, sub- paragraphs (2) and (4) are deleted and re- E. ADDITIONAL COVERAGES placed with the following: SECTION III - PHYSICAL DAMAGE COVER- (2) Up to $5,000 for cost of bail AGE,A. Coverage, is amended to include the bonds (including bonds for re- following additional coverage items: lated traffic law violations) re- quired because of an "accident" 5. We will pay the expense of returning a stolen covered "auto" to you. we cover. We do not have to furnish these bonds. 6. Fire Department Service Charge (4) All reasonable expenses in- When a fire department is called to save curred by the "insured" at our or protect a covered "auto", its equip- request, including actual loss of ment, its contents or occupants from a earnings up to $500 per day be- Covered Cause Of Loss, we will pay up cause of time off from work. to $1,000 for your liability for Fire De- partment Service Charges: C. FELLOW EMPLOYEE EXCLUSION AMEND- MENT - (a) Assumed by contract or agreement SECTION II - COVERED AUTOS LIABILITY prior to loss; or COVERAGE, item B. Exclusions, 5. Fellow (b) Required by local ordinance. Employee does not apply if the "bodily injury" results from the use of a covered "auto" you No deductible applies to this additional own or hire. coverage. D. COVERAGE EXTENSIONS F. AIRBAG COVERAGE - ACCIDENTAL DIS- SECTION III - PHYSICAL DAMAGE COVER- CHARGE AGE, Item A. Coverage, 4. Coverage Exten- SECTION III - PHYSICAL DAMAGE COVER- sions, a.Transportation Expenses is replaced AGE, Item B. Exclusions, subparagraph 3.a. with the following: is deleted and replaced with the following: CA 70 78 10 13 Page 2 of 3 a. Wear and tear, freezing, mechanical I. UNINTENTIONAL FAILURE TO DISCLOSE or electrical breakdown. Mechanical HAZARDS breakdown does not apply to the ac- Under SECTION IV - BUSINESS AUTO CON- cidental discharge of an airbag. DITIONS, B. General Conditions, 2. G. GLASS REPAIR - WAIVER OF DEDUCTIBLE Concealment, Misrepresentation Or Fraud is amended to include the following additional SECTION III - PHYSICAL DAMAGE COVER- paragraph: AGE, item D. Deductible the following para- graph is added: If you unintentionally fail to disclose any hazards existing at the inception date of No deductible shall apply to glass dam- your policy, we will not deny coverage age if the glass is repaired rather than under this Coverage Part because of replaced. such failure. H. KNOWLEDGE AND NOTICE OF AN ACCI- J. WORLDWIDE COVERAGE DENT, CLAIM OR SUIT Under SECTION IV - BUSINESS AUTO CON- DITIONS, B. General Conditions, 7. Policy SECTION IV - BUSINESS AUTO CONDITIONS, Period, Coverage Territory, subparagraph (5) Item A. Loss Conditions is amended as fol- is deleted and replaced with the following: lows: (5) Anywhere in the world, if: Subparagraph a. under Item 2. Duties In The Event Of Accident, Claim, Suit Or (a) A covered "auto" le the private Loss, is amended to include the following passenger type is leased, hired, paragraphs: rented or borrowed without a driver for a period of 45 days or This requirement applies when the less; and "accident," claim, "suit" or "loss" is (b) The "insured's" responsibility to first known to: pay damages is determined in (1) You, if you are an individual; a "suit" on the merits, in the United States of America, the (2) A partner, if you are a partner- territories and possessions of ship; or the United States of America, Puerto Rico or Canada or in a (3) An executive officer or insur- settlement we agree to. ance manager, if you are a cor- (c) If, for such "autos" a "suit" is poration. brought outside the territory de- Subparagraph b.(2) under 2. Duties In scribed in T(1) through 7.(4) The Event Of Accident, Claim, Suit Or above, we will reimburse the insured for defense expenses Loss is amended as follows: incurred with our written con- (2) Immediately send us copies of sent, but we will make no pay- any request, demand, order, ment, nor will we reimburse the notice, summons or legal paper insured for damages, received concerning the claim K. DEFINITIONS or "suit." Under SECTION V - DEFINITIONS, Item C. is Your employees may know of replaced by the following: documents received concerning a claim or "suit". This will not C. "Bodily injury" means bodily injury, sick- mean that you have such know- ness or disease sustained by a person, ledge, unless receipt of such including mental anguish, mental injury documents is known t you, any or death resulting from any of these. of your executive officers or "Bodily injury" includes mental anguish partners or your insurance or other mental injury resulting from "bodily injury". manager. 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 1. All work, including materials, parts or include as an additional insured the person(s) equipment furnished in connection with or organization(s) shown in the Schedule, but such work, on the project (other than only with respect to liability for "bodily injury", service, maintenance or repairs) to be "property damage" or "personal and adver- performed by or on behalf of the addi- tising injury" caused, in whole or in part, by: tional insured(s) at the location of the covered operations has been completed; 1. Your acts or omissions; or or 2. The acts or omissions of those acting on 2. That portion of "your work" out of which your behalf; the injury or damage arises has been put in the performance of your ongoing oper- to its intended use by any person or or- ations for the additional insured(s) at the ganization other than another contractor location(s) designated above. or subcontractor engaged in performing operations for a principal as a part of the However: same project. 1. The insurance afforded to such additional C. With respect to the insurance afforded to insured only applies to the extent per- these additional insureds, the following is mitted by law; and added to Section III - Limits Of Insurance: 2. If coverage provided to the additional in- If coverage provided to the additional insured sured is required by a contract or agree- is required by a contract or agreement, the ment, the insurance afforded to such most we will pay on behalf of the additional additional insured will not be broader insured is the amount of insurance: than that which you are required by the 1. Required by the contract or agreement; contract or agreement to provide for or such additional insured. 2. Available under the applicable limits of B. With respect to the insurance afforded to insurance; these additional insureds, the following addi- tional exclusions apply: whichever is less. This insurance does not apply to "bodily in- This endorsement shall not increase the ap- jury" or "property damage" occurring after: plicable limits of insurance. ©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. 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 contract or agreement to provide for include as an additional insured the person(s) such additional insured. or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" B. With respect to the insurance afforded to or "property damage" caused, in whole or in these additional insureds, the following is part, by "your work" at the location desig- added to Section III - Limits Of Insurance: nated and described in the schedule of this If coverage provided to the additional insured endorsement performed for that additional is required by a contract or agreement, the insured and included in the "products completed operations hazard". most we will pay on behalf of the additional insured is the amount of insurance: However: 1. Required by the contract or agreement; 1. The insurance afforded to such additional or insured only applies to the extent per- mitted by law; and 2. Available under the applicable limits of 2. If coverage provided to the additional in- insurance; sured is required by a contract or agree- whichever is less. ment, the insurance afforded to such additional insured will not be broader This endorsement shall not increase the ap- than that which you are required by the plicable limits of insurance. ©insurance Services Office, Inc,,2018 CG 20 37 12 19 PINNACOL 7501 E. Lowry Blvd. ASSURANCE Denver, CO 80230-7006 303.361.4000/800.873.7242 Pinnacol.com NCCI #: WC000313B Policy#: 4025271 L & M Underground Inc CRS, Commercial Risk Solutions, Inc 7529 S. Storm Mtn 9780 S Meridian Blvd Suite 400 Littleton, CO 80127 Englewood, CO 80112 (303) 996-7800 ENDORSEMENT: Blanket Waiver of Subrogation 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, 2025 Expires on: January 1, 2026 Pinnacol Assurance has issued this endorsement November 15, 2024 7501 E. Lowry Blvd Denver,CO 80230-7006 Page 1 of 1 P ROSSIGNB-Underwriter 11/15/2024 11:27:13 4025271 84336738 359-B