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HomeMy WebLinkAboutBlusky Restoration Contractors, LLC - Insurance Certificate 2024-2025 ® DAT (03/07/ YYY) /22024 CERTIFICATE OF LIABILITY INSURANCE 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. w IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.If m 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 -a Aon Risk Services Central, Inc. NAME: Chicago IL office (A/C.No.Ext): (303) 758-7688 (aC.No.: (303) 758-9458 131 200 East Randolph ADDRESS: _ Chicago IL 60601 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Zurich American Ins Co 16535 Blusky Restoration Contractors, LLC INSURERB: 9110 East Nichols Avenue Suite 180 centennial Co 80112 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570104245765 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED PREMISES Ea occurrence MED EXP(Any one person) PERSONAL&ADV INJURY Lr) r GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ul v POLICY ❑PRO-CT LOC PRODUCTS-COMP/OP AGG o JE OTHER: n A BAP 3487148-17 04/01/2024 04/01/2025 COMBINED SINGLE LIMIT rn AUTOMOBILE LIABILITY Ea accident) $5,000,000 ANY AUTO BODILY INJURY(Per person) G Z X OWNED SCHEDULED BODILY INJURY(Per accident) N AUTOS ONLY AUTOS M X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident) r d UMBRELLA LIAB OCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION A WORKERS COMPENSATION AND wC302953104 04 01 2024 04 01/2025 X PER STATUTE I OTRH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? F N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 II yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $1,000,000— DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Fort Collins, 281 N. College Ave., Fort Collins, Co 80524 is included as Additional Insured in accordance with the policy provisions of the Automobile Liability policy. Automobile Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A waiver of Subrogation is granted in favor of Additional insured in accordance with the policy provisions of the Automobile Liability and workers' Compensation policies. [� r CERTIFICATE HOLDER CANCELLATION 4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE i EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE �� ) POLICY PROVISIONS. i City Of Fort Collins AUTHORIZED REPRESENTATIVE i 281 N. college Ave. I Fort Collins Co 805Z4 USA •_ 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Coverage Extension Endorsement ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. AWL Prem Return Prem. BAP 3487148-17 4/1/2024 4/1/2025 4/1/2024 30-380000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who Is An Insured 1. The following is added to the Who Is An Insured Provision in Section II—Covered Autos Liability Coverage: The following are also "insureds": a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. Any"employee"of yours is also an"insured"while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. b. Anyone volunteering services to you is an "insured"while using a covered "auto"you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement. d. Where and to the extent permitted by law, any person(s) or organization(s)where required by written contract or written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you, provided the "accident" arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations,whichever is less. 2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance— Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form: Coverage for any person(s) or organization(s), where required by written contract or written agreement with you executed prior to any"accident", will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the Coverage Form. B. Amendment—Supplementary Payments Paragraphs a.(2) and a.(4)of the Coverage Extensions Provision in Section II—Covered Autos Liability Coverage are replaced by the following: (2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident"we cover. We do not have to furnish these bonds. U-CA-424-F CW(04/14) Page 1 of 6 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE I 02/27,2025 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 d Aon Risk Services Central, Inc. NAME: Chicago IL Office (A C.No.Ext): (303) 755-7688 FAX No.: (303) 758-9458 d 200 East Randolph E-MAIL p Chicago IL 60601 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Zurich American ins Co 16535 Blusky Restoration Contractors, LLC INSURERB: 9110 East Nichols Avenue suite 180 Centennial CO 80112 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570111042976 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. Limits shown are as requested INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE ❑OCCUR PREMISES Ea occurrence MED EXP(Any one person) PERSONAL&ADV INJURY to GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE N POLICY PRO- 0 JECT LOC PRODUCTS-COMP/OPAGG OTHER: o n A AUTOMOBILE LIABILITY BAP 3487148-18 04/01/2025 04/01/2026 COMBINED SINGLE LIMIT Ea accident $2,000,000 ANYAUTO BODILY INJURY(Per person) Z X OWNED SCHEDULED BODILY INJURY(Per accident) 4) AUTOS X HIREDAUOTOS X NON-OWNED PROPERTY DAMAGE 0 ONLY AUTOS ONLY Per accident) r tL UMBRELLALIAB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION A WORKERS COMPENSATION AND WC302953105 04 01 2025 04 01 2026 X PER STATUTE OTH- EMPLOYERS'LIABILITY Y/N ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER MEMBER EXCLUDED? F9 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000— DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Z1 City of Fort Collins is included as Additional Insured in accordance with the Policy provisions of the Automobile Liability policy. Automobile Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A waiver of Subrogation is granted in favor of Additional insured in accordance with the policy provisions of the Automobile Liability and workers' Compensation policies. CERTIFICATE HOLDER CANCELLATION 0 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE n EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 'J POLICY PROVISIONS. City of58ort Collins AUTHORIZED REPRESENTATIVEPO Box 0 Fort Collins Co 80522 USA ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD