Loading...
HomeMy WebLinkAbout380591 J 2 CONTRACTORS - INSURANCE CERTIFICATEClient#: 52036 R.12rONTR ACORD,. CERTIFICATE OF LIABILITY INSURANCE 01J1010,DYYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH of Colorado ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 720 South Colorado Boulevard HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 60ON Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIC # INSURED J-2 Contracting Company P.O. Box 129 Greeley, CO 80632 INSURER A. Bituminous Casualty Corp. 20095 INSURER B: Pinnacol Assurance 10780 INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR 4LDD'LPOLICY INSRE TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DAT D POLICY EXPIRATION T M D V LIMITS A GENERAL LIABILITY CLP3222807 01/01/07 01/01/08 EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurren , $100 000 CLAIMS MADE a OCCUR MED EXP (Any one person) $5 000 PERSONAL a ADV INJURY $1 000 000 $1000 PD Deductible GL4382(12/04) GENERAL AGGREGATE s2,000,000 Addl Ins Form GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGG $2000000 POLICY I X I jECOT 17 LOG A AUTOMOBILE LIABILITY ANY AUTO CAP3503043 01/01/07 I lJ1' 01/01/08 COMBINED SINGLE LIMIT $1 000 000 ' ' X BEODILY NJtURY (Per person) $ ALL OWNED AUTOS SCHEOULEDAUTOS I ^` I j�l • .LLV,I�JJ I�jwf LSU X INJURY (Per accident) $ HI RED AUTOS NON -OWNED AUTOS (}BODILY X PROPERTY DAMAGE (Per accident) $ CITY F FOR COI.,LIN( 1 GARAGE LIABILITY A I 11 1-1.r.i7 AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESSIUMBRELLA LIABILITY CUP2577990 01/01/07 01/01/08 EACH OCCURRENCE $1,000,000 X1 OCCUR ❑ CLAIMS MADE AGGREGATE $1,000,000 $ DEDUCTIBLE $ X RETENTION $ 1 O 000 B WORKERS COMPENSATION AND 3114522 10101106 10101107 X WC sraru- oTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. EACH ACCIDENT $1 1 OOO 1 OOO E.L. DISEASE - EA EMPLOYEE $1,000,000 It yes, describe under SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT 1 $1,000,000 A OTHER Leased/ CLP3222807 01/01/07 01/01/08 $300,000 Special Form Rented Equipment $1,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Project: Oak Street Plaza, Fort Collins, CO The following are Additional Insureds as respects General Liability (See Attached Descriptions) The City of Fort Collins 300 Laporte Avenue Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *An DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVE ACORD 25 (2001/08) 1 of 3 NM510765 8LBEL © ACORD CORPORATION 1988 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ADDITIONAL INSURED ENDORSEMENT - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION II - WHO IS AN INSURED is amended to include: Any "owner", "contractor", "construction manager", "engineer" or "architect" if it is required in your written contract or written agreement executed by you and all other parties to the contract or agreement prior to any loss that such person(s) or organization(s) be added as an additional insured on your policy for completed operations but only for the project designated in your written contract or written agreement and only with respect to "bodily injury" or "property damage" included in the "products -completed operations hazard" and caused, at least in part, by your negligence and with respect to liability resulting from: A. "Your work" performed for the additional insured(s), or B. Acts or omissions of the additional insured(s) in connection with their general supervision of "your work". With respect to the insurance afforded such additional insureds in connection with this endorsement and the above referenced Commercial General Liability Form, the following additional provisions apply to limit that coverage: 1. We will have no duty to defend the additional insured against any "suit" seeking damages for "bodily injury" or "property damage" until we receive written notice from the additional insured requesting that we defend it in the "suit." 2. The Limits of Insurance applicable to the additional insureds under this endorsement are the minimum limits specified in the written contract or agreement requiring this coverage, or as stated in SECTION III - LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM, whichever is less. These Limits of Insurance are inclusive of and not in addition to the Limits of Insurance described in SECTION III of that form. 3. As additional conditions of coverage under this form, an additional insured under this endorsement will as soon as practicable: a. Give written notice to us of an "occurrence" which may result in a claim. This shall include: (1) How, when and where the "occurrence" took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence". b. Give written notice to us of a claim or "suit" brought against the additional insured including specifics of the claim or "suit" and the date it was received. C. Give written notice of such claim or "suit," including a demand for defense and indemnity, to any other insurer who had coverage for the claim or "suit" under its policy(ies), either at the time of, or at any time subsequent to the occurrence of the "bodily injury" or "property damage" which is the basis for such claims or "suit." (1) Such notification must demand the full coverage available under that policy; and GL-4382 (12/04) 1_ (2) The additional insured shall not take any action to waive or limit such other coverage available to it. 4. This insurance does not apply to: a. "Bodily injury" or "property damage" resulting from any act or omission of the additional insured(s) or any of their employees, other than the general supervision of work performed for the additional insured(s) by you; b. "Bodily injury" or "property damage" resulting from "your work" performed on a project where other valid and collectible insurance is available to the additional insured under an Owner Controlled Insurance Program or Consolidated (wrap-up) Insurance Program; c. "Bodily injury" or "property damage" (1) In connection with a project where "your work" on the project was completed prior to the effective date of this policy, unless the written contract or written agreement includes a specific time requirement for completed operations coverage to be provided by you for the additional insured for "bodily injury" or "property damage" occurring during the policy period. (2) In connection with a project where "your work" on the project was completed and where the duration of the additional insured coverage requirement in the written contract or written agreement governing "your work" on that project had expired by the time that the injury or damage first occurred. (3) In connection with a project where "your work" on the project was completed more than thirty six (36) months prior to the effective date of this policy. For the purpose of this endorsement, "your work" will be deemed completed as set forth in the "products -completed operations hazard" definition. d. "Bodily injury" or "property damage": (1) Arising out of the rendering or failure to render any professional services by any insured, or on their behalf, but only with respect to either or both of the following operations; (a) Providing engineering, architectural or surveying services to others in the insured's capacity as an engineer, architect or surveyor, and (b) Providing, or hiring independent professionals to provide, engineering, architectural or surveying services in connection with work the insured performs. (2) Subject to paragraph (3) below, professional services include: (a) The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and (b) Supervisory or inspection activities performed as part of any related architectural or engineering activities, but does not include the general supervision of your operations on such project. GL-4382 (12/04) -2- (3) Professional services do not include services within construction means, methods, techniques, sequences and procedures employed by you in connection with your operations as a construction contractor. For the purpose of this endorsement, the following definitions are added: "Owner" means a person or organization who has ownership in the project premises designated in your written contract or written agreement, at which you are performing or performed work. "Contractor" means a person or organization with whom you have agreed in a written contract or written agreement to perform work for at the project designated in the written contract or written agreement. "Construction Manager" means a person or organization designated as "construction manager" in your written contract or written agreement, and has management or supervisory responsibilities over "your work" for the project designated in the written contract or written agreement. "Engineer" means a person or organization who has been engaged by the 'owner", "contractor" or "construction manager" to perform engineering services for the project designated in your written contract or written agreement and has a contractual responsibility for supervising, directing or controlling "your work" on such project. "Architect" means a person or organization who has been engaged by the 'owner", "contractor" or "construction manager" to perform architectural services for the project designated in your written contract or written agreement and has a contractual responsibility for supervising, directing or controlling "your work" on such project. Any coverage provided herein will be excess over any other valid and collectable insurance available to the additional insured(s) whether primary, excess, contingent or on any other basis unless you have agreed in a written contract or written agreement executed prior to any loss that this insurance will be primary. However, any insurance specifically purchased for a designated project(s), including but not limited to additional insured coverage, owners contractors protective coverage, etc., will be primary with the insurance provided by this endorsement being excess. If this insurance is determined to be primary, we agree not to seek contribution from such other insurance only if you have so agreed in the written contract or written agreement. In no event will any coverage provided under this endorsement extend beyond the expiration date of this policy. GL-4382 (12/04) -3- IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25S (2001/08) 2 of 3 #M510765 DESCRIPTIONS (Continued from Page 1) only If required by written contract and coverage applies only as respects ongoing operations performed by the Insured for the Additional Insureds. Additional Insureds: The City of Fort Collins All coverage terms, conditions and exclusions of the policy apply. The Additional Insured endorsement which is referenced above under "Type of Insurance -General Liability" is attached. * The following cancellation conditions always apply: -10 days for non-payment of premium - If policy shown, 10 days for Workers' Compensation for fraud; material misrepresentation; non-payment of premium; other reasons approved by the Commissioner of Insurance AM5 25.3 (2001/08) 3 of 3 #M510765 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ADDITIONAL INSURED ENDORSEMENT - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION II - WHO IS AN INSURED is amended to include: Any 'owner", 'contractor", 'construction manager", "engineer" or "architect' if it is required in your written contract or written agreement executed by you and all other parties to the contract or agreement prior to any loss that such person(s) or organization(s) be added as an additional insured on your policy for completed operations but only for the project designated in your written contract or written agreement and only with respect to "bodily injury" or "property damage" included in the "products -completed operations hazard" and caused, at least in part, by your negligence and with respect to liability resulting from: A. "Your work" performed for the additional insured(s), or B. Acts or omissions of the additional insured(s) in connection with their general supervision of "your work". With respect to the insurance afforded such additional insureds in connection with this endorsement and the above referenced Commercial General Liability Form, the following additional provisions apply to limit that coverage: 1. We will have no duty to defend the additional insured against any "suit' seeking damages for "bodily injury" or "property damage" until we receive written notice from the additional insured requesting that we defend it in the "suit." 2. The Limits of Insurance applicable to the additional insureds under this endorsement are the minimum limits specified in the written contract or agreement requiring this coverage, or as stated in SECTION III - LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM, whichever is less. These Limits of Insurance are inclusive of and not in addition to the Limits of Insurance described in SECTION III of that form. 3. As additional conditions of coverage under this form, an additional insured under this endorsement will as soon as practicable: a. Give written notice to us of an 'occurrence" which may result in a claim. This shall include: (1) How, when and where the 'occurrence" took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the 'occurrence". b. Give written notice to us of a claim or "suit' brought against the additional insured including specifics of the claim or "suit' and the date it was received. C. Give written notice of such claim or "suit," including a demand for defense and indemnity, to any other insurer who had coverage for the claim or "suit' under its policy(ies), either at the time of, or at any time subsequent to the occurrence of the "bodily injury" or "property damage" which is the basis for such claims or "suit." (1) Such notification must demand the full coverage available under that policy; and GL-4382 (12/04) 1- (2) The additional insured shall not take any action to waive or limit such other coverage available to it. 4. This insurance does not apply to: a. "Bodily injury" or "property damage" resulting from any act or omission of the additional insured(s) or any of their employees, other than the general supervision of work performed for the additional insured(s) by you; b. "Bodily injury" or "property damage" resulting from "your work" performed on a project where other valid and collectible insurance is available to the additional insured under an Owner Controlled Insurance Program or Consolidated (wrap-up) Insurance Program; c. "Bodily injury" or "property damage" (1) In connection with a project where "your work" on the project was completed prior to the effective date of this policy, unless the written contract or written agreement includes a specific time requirement for completed operations coverage to be provided by you for the additional insured for "bodily injury" or "property damage" occurring during the policy period. (2) In connection with a project where "your work" on the project was completed and where the duration of the additional insured coverage requirement in the written contract or written agreement governing "your work" on that project had expired by the time that the injury or damage first occurred. (3) In connection with a project where "your work" on the project was completed more than thirty six (36) months prior to the effective date of this policy. For the purpose of this endorsement, "your work" will be deemed completed as set forth in the "products -completed operations hazard" definition. d. "Bodily injury" or "property damage": (1) Arising out of the rendering or failure to render any professional services by any insured, or on their behalf, but only with respect to either or both of the following operations; (a) Providing engineering, architectural or surveying services to others in the insured's capacity as an engineer, architect or surveyor, and (b) Providing, or hiring independent professionals to provide, engineering, architectural or surveying services in connection with work the insured performs. (2) Subject to paragraph (3) below, professional services include: (a) The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and (b) Supervisory or inspection activities performed as part of any related architectural or engineering activities, but does not include the general supervision of your operations on such project. GL-4382 (12/04) -2- (3) Professional services do not include services within construction means, methods, techniques, sequences and procedures employed by you in connection with your operations as a construction contractor. For the purpose of this endorsement, the following definitions are added: "Owner" means a person or organization who has ownership in the project premises designated in your written contract or written agreement, at which you are performing or performed work. "Contractor" means a person or organization with whom you have agreed in a written contract or written agreement to perform work for at the project designated in the written contract or written agreement. "Construction Manager" means a person or organization designated as "construction manager" in your written contract or written agreement, and has management or supervisory responsibilities over "your work" for the project designated in the written contract or written agreement. "Engineer" means a person or organization who has been engaged by the 'owner", 'contractor" or "construction manager" to perform engineering services for the project designated in your written contract or written agreement and has a contractual responsibility for supervising, directing or controlling "your work" on such project. "Architect" means a person or organization who has been engaged by the 'owner", 'contractor" or "construction manager" to perform architectural services for the project designated in your written contract or written agreement and has a contractual responsibility for supervising, directing or controlling "your work" on such project. Any coverage provided herein will be excess over any other valid and collectable insurance available to the additional insured(s) whether primary, excess, contingent or on any other basis unless you have agreed in a written contract or written agreement executed prior to any loss that this insurance will be primary. However, any insurance specifically purchased for a designated project(s), including but not limited to additional insured coverage, owners contractors protective coverage, etc., will be primary with the insurance provided by this endorsement being excess. If this insurance is determined to be primary, we agree not to seek contribution from such other insurance only if you have so agreed in the written contract or written agreement. In no event will any coverage provided under this endorsement extend beyond the expiration date of this policy. GL-4382 (12/04) -3- ACORDTM CERTIFICATE OF LIABILITY INSURANCE 01/10107°"""' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH of Colorado ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 720 South Colorado Boulevard HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 600N Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Bituminous Casualty Corp. 20095 J-2 Contracting Company INSURER B: Pinnacol Assurance 10780 P.O. BOX 129 Greeley, CO 80632 INSURER C: INSURER D: INSURER E: NWVQrW C,l 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DA DIYYDATE POLICY EXPIRATION MW LIMITS A GENERAL LIABILITY CLP3222807 01/01/07 01/01/08 EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fx� OCCUR DAMAGE TO RENTED $100 QQQ MED EXP (Any one person) $5 QQQ $1000 PD Deductible PERSONAL BADVINJURY $1 000000 GL4382(12/04) GENERALAGGREGATE $2 000 000 Addl Ins Form GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X JEa7 LOC A AUTOMOBILE LIABILITY ANY AUTO CAP3503043 ,w/07. — 01/01/08 7 COMBINED SINGLE LIMIT (Ea accident) 1 $1,000,000 QQQ 000 X BODILY INJURY (Perperson) $ ALL OWNED AUTOS SCHEDULED AUTOS _ "^-�- �.`- HIRED AUTOS NON -OWNED AUTOS ^Ft!I OF X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GAR AGE LIABILITY f-"L' AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE CUP2577990 01/01/07 01/01/08 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DEDUCTIBLE X RETENTION $ 10 000 $ B WORKERS COMPENSATION AND - EMPLOYERS' LIABILITY 3114522 10101106 10/01107 V WCSTATU- I OTH- � I TOR LIMIT E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, tlescribs under E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 SPECIAL PROVISIONS below A OTHER Leased/ CLP3222807 01/01/07 01/01/08 $300,000 Special Form Rented Equipment $1,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project: LPATH Berm Erosion Protection Measures, Fort Collins, CO The following are Additional Insureds as respects General Liability only if required by written contract and coverage applies only as respects (See Attached Descriptions) City of Fort Collins 215 N Mason Street, 2nd Floor Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVE -•-- -�---•'��I 1 014 FFMOTurbD 8LBEL © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. MIi Mu zuti rAuu-vua) 2 Of 3 #M510765 DESCRIPTIONS (Continued from Page 1) work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. Additional Insureds: City of Fort Collins and Anderson Constulting Engineers The Additional Insured endorsement which Is referenced above under "Type of Insurance -General Liability" is attached. * The following cancellation conditions always apply: -10 days for non-payment of premium - If policy shown, 10 days for Workers' Compensation for fraud; material misrepresentation; non-payment of premium; other reasons approved by the Commissioner of Insurance AMS 25.3 (2001l08) 3 of 3 #M510765