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HomeMy WebLinkAbout380591 J 2 CONTRACTORS - INSURANCE CERTIFICATE (2)Client#: 52036 8J2CONTR ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE (MMID 03/09/07DNYYY) 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 Suite 600N HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIC # INSURED J-2 Contracting Company P.O. Box 129 INSURER A: Bituminous Casualty Corp. 20095 INSURER B: Pinnacol Assurance 10780 Greeley, CO 80632 INSURER C: INSURER D: INSURER E: :c 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. LTR INSRC TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMM/DDfM POLICY EXPIRATION DATE IMMIDDYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR Add'[ Ins End CLP3237001 01/01/07 01/01/08 EACH OCCURRENCE $1 OOOOOO DAMAGE TO RENTEDPREMISES (Fa occurrence) $1 OO OOO $5 000 MED EXP (Any one person) PERSONAL & ADV INJURY $1 00O 000 GL-4382 (12104) GENERAL AGGREGATE $2 00O 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7x PRO X LOC PRODUCTS - COMP/OP AGG $1 1 OOO1 OOO A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CAP3509264 CITY 01/01/07 �� �! �,, R.I� OF FORT 01/01/08 � 2007 COLLINS COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X Per accidILY ent) $ X PROPERTY DAMAGE (Per (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESSIUMBRELLA LIABILITY X1 OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION $ 1 O 000 CUP2579804 01/01/07 01/01/08 EACH OCCURRENCE $1 1 OW OW 0- 0- 0- 0- AGGREGATE $1 000 000 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 3114522 10/01/06 10/01/07 X I WC STATU- I IOTH- DRYIM1I E.L. EACH ACCIDENT $1 00,000 SE - EA EMPLOYEE $1 00O 000 E.L. DISEASE - POLICY LIMIT $1 00O O00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I 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 Rn* 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 ^��^� ���� •r��I l OT a 8111101 /U7 b 8CMAR 0 ACORD CORPORATION 1988 S. CONTRACTORS AUTOMATIC ADDITIONAL INSURED COVERAGE 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 but only for the project designated in your written contract or written agreement and only with respect to "bodily injury;' "property damage" or "personal and advertising injury" caused, at least in part, by your negligence and with respect to liability resulting from: A. Your ongoing operations for the additional insured(s), or B. Acts or omissions of the additional insured(s) in connection with their general supervision of such operations. With respect to the insurance afforded such additional insureds pursuant to this endorsement and the above referenced 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;' "property damage" or "personal and advertising injury," 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" or an offense which may result in a claim. This shall include: (1) How, when and where the "occurrence" or offense 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" or offense. . 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," "property damage" and/or the offense causing the "personal and advertising injury," which is the basis for such claims or "suit". (1) Such notification must demand the full coverage available under that policy; and (2) The additional insured shall not take any action to waive or limit such other coverage available to it. GL-3088 (01/06) -2- 4. This insurance does not apply to: a. "Bodily injury" "property damage" or "personal and advertising injury" occurring after: (1) All work on the project (other than service, maintenance, or repairs) to be performed by you or on your behalf for the additional insured(s) has been completed; or (2) 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- b. "Bodily injury" "property damage" or "personal and advertising injury" 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. c. "Bodily injury" "property damage" or "personal and advertising injury" resulting from 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. d. "Bodily injury," "property damage" or "personal and advertising injury": (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. (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 operations. "Contractor" means a person or organization with whom you have agreed in a written contract or written agreement to perform operations for at the project designated in the written contract or written agreement. GL-3088 (01106) -3- "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 operations for the project designated in your 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 operations 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 operations 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 other 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. C. AUTOMATIC WAIVER OF SUBROGATION Item 8. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, is deleted and replaced with the following: 8. Transfer of Rights of Recovery Against Others to Us and Automatic Waiver of Subrogation. a. If the insured has rights to recover all or part of any payment we have made under this Coverage Form, those rights are transferred to us. The insured must do nothing after loss to impair those rights. At our request, the insured will bring "suit' or transfer those rights to us and help us enforce them. b. If required by a written contract executed prior to loss, we waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of "your work" for that person or organization. D. EXTENDED NOTICE OF CANCELLATION, NONRENEWAL Item A.2.b, of the COMMON POLICY CONDITIONS, is deleted and replaced with the following: A.2.b. 60 days before the effective date of the cancellation if we cancel for any other reason. Item S. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, is deleted and replaced with the following: 9. WHEN WE DO NOT RENEW a. If we choose to nonrenew this policy, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. b. If we do not give notice of our intent to nonrenew as prescribed in a. above, it is agreed that you may extend the period of this policy for a maximum additional sixty(60) days from its scheduled expiration date. Where not otherwise prohibited by law, the existing terms, conditions and rates will remain in effect during that extension period. It is further agreed GL-3088 (01/06) -4- 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. •--1 a up a fsm;Irv10 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 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFUL. CONTRACTORS ADDITIONAL iNSURED ENDORSEMENT - COMPLETED Ol This endorsement modifies insurance• provided under the foliowingi,.' COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION 11- WHO IS AN INSURED is amended to Include Any "owner" "contractor", "construction manager", "engineer".or "architect" if it is requir contract or;wri. an agreement executed by you and all,other parties.to the contract or any loss that such person(s) or organization(s.-be`,added;as;:an.additional'insured;c completed; operations but only for the project designated in your written contract or't and only, with 'xespect to "bodily injury" or "property '.damage° included in `the "p'ri operation, hazard" and caused, at least in part. by your, negligence and whh'respeot tc from: A. "Your:46rk" performed for the additional msured(s), or._ " B. Acts or,omissions of the additional insureds) in 'connection with their general sul worlel.l With respect to4.the insurance afforded such additlonal ini ids" in connection with this the above yefereneed Commercial General I lability Formllthe following additional provis that coverage i i 1, rvision of "yo',ur dorsement and ns apply to limit, We 41 IjaVe no duty to defend the additional insured against any "suit seeking damage's for "bodily I injur} " or "property damage" until we receive_ written :notice from the additional insured requesting r that we defend it in the "suit." . 2. The L imits of Insurance applicable to the .additional insureds under ,this endorsement are the minimum limits specified in the written contract or agreement requiring!t Ia. coyerage, or as stated in SECTION:111- LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM,.whichever is less. These Limits of Insurance are inclusive of and not: i addition to the Limits of Insurance described in SECTION IIi of that form. i l 3. AS additional conditions of Coverage under this..form, an additional insured under this endorsement will as soon as practicable: l a. Give Written notice to us of an "occurrence° nhrch may result in a claim. This I hall include. i. (t) .How, when and where the "occurrence" took place; I (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 "oocurrlence". b. Give written notice to us of a claim or "suit" brought against the additional insured including speafics of the claim or "suit" and the date it was received I 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:bf, or at anytime subsequent to the occurrence of the "bodily injury' on"Iroperyy damage" Which is the basis for such claims or "suit ": (1) such notification must demand the full coverage available under that policy; and OL4382 (12104) 1; 6b/Lt'"d Boeo s80 £9.£ 33Nu2JnSNI snONIwniia S£:60 900E—Se=d3S I °Bodily injury" or "property damage , resulting from any act or omission of the, additional insureds) or any of their employees, .other_than.the.general supervision of work performed Ior the additional insured(s) by you; "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 Consolldated (wrap-up) insurance`P,rogram; i °Bodily injury" or ;:property damage" I j' (1) In connection with a project where "yo.Ur work" on the pro*t was comp etediprior to the effective date of this policy, unless the 5luntten'cantract 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 "prope[ty'damage' ocourringi ryuring Its tSolic)i period. ! (2) In connection with a project where "your work" on the prajectyv as completed and where the duration of the additional insured coverage requirement in the wr`ttencontract -or written agreement governing "your •work;' on,.that project had expired br :he time that the Injury or damage first occurred ! j . (3) . In connection with a project where "your work" on the project was cornpieted Amore than thirty six (38) months prior to the effective idatiof this policy or tBe purpose of this endorsement, "yoyr, work" will be deemed completed as set forth in the products -completed operations hazard" .de ni K' n "Bodily Injury" or "property damage",. (1) Arising out of the rendering or fallure to render.. any professlonal .�ervices by any Insured, or on their behalf but only with respect to either or both of the following operations; f ;. (a) Providing engineering, 'architectural or surveying !services, to others In: the insured's capacity as an engineer, architect or surveyor, and I j (b) Providing, or hiring independent professionals ' to provide, engineering; architectural or suryyrneg. services in connection with work the insured performs. (2) Subject to paragraph (3) below,'professlottal services include: I' (a) The preparing, approving orfaiiing to prepare or approve maps, shop drawings, opinions, reports, surveys; field :;brders, ,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 operationson such project. I ' GL4382 (12/04) 65/817"cl 8080 SeF 202 a. b. 0. 3JN13af1SNI SnQNIwniia S£.:60 900e--T0 03S i Professional services do not Include services Within construction rrieans, methods, techniques, sequences and pro cedUrfet'amployied by you in connection with your f. operations as a construction contractor. For the purpose of this endorsement, the following defl.06ha'are added: 'Owner -means a person or organization who has ownership in the project prey IsIi;s;deslgnated in your written contract or written agreemaint, at Which you are -performing or performed work. "Contra6tor" means a person or organization withwhom you have agreed 16 a;wrftten. contract or wrliten'agreement to perform work for at theproject designated In the Written contract or wntten agreement. "Construction Manager" means a person or organization -- designated as "constru' ion ana Q . YOU!, written contract or written agreement, and has management or supervisory res nslbillties Over your work" for the project designatid in the written contractor written -agreement' "Enginear" means a person or organization who has, been engaged by the "owneeil "odritractor"or. your written construction manager" to perform engineering services for the project designated u contract.,or written agreement and has a contractual responsibility. for supervising, directing or controlling"your work" on such project "Arohitect" means a person or organization who' been engaged by the "owner","contractor" or "construction manager" to perform architectural services for the project designat6d in our wrmpn contract. or written agreement and has .4 contractual % responsibility for supervising, directing or i4 coritrallih "Your work' on such project 2.9 J Any coverage provided herein will be excess over any othdivaffd and collectable insurance available to the ...4. oth4'r basis* 'uh] 'agreed in a addltional insured ess you have .9 OON ,(a) whether primary, excess, conVngent or'on any written treo ften agreement executed prior n orwrl call chased 'or a deal, nsurar� 5 OCI y pu' lve L toot 0 co �wrltten agreement any loss insurance will be primary. However, any c. including but not limited to additional ns d co�m e o"Ors contractors protective primary with the insurance pmvIdW' I ureco' I I b t a a c t bein excess. this insurance beprimar! , we agree flat to,se y I nd rabmen g ce If 5 y 10 om. if I co d W r insurance 0 Y y in the Written contracl or Written contribution n from s�� other in anc only agreement. In no event will any coverage provided under this endorsement extend beyond the expi ion date of this policy. 7. GL-4382 (12/04) 617/6t7 'd 8080 S8,.S 202 39N)38nSN1 sn0Niwn11E1 92:66 900Z—T013S ACORD- CERTIFICATE OF LIABILITY INSURANCE 0DATE 3/0907D � 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 INSURER A: Bituminous Casualty Corp. 20095 J-2 Contracting Company INSURER B: Pinnacol Assurance 10780 P.O. Box 129 INSURER C: Greeley, CO 80632 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. LT R D NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE T D POLICY EXPIRATION DATE D LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 51OCCUR Add'1 Ins End CLP3237001 01/01/07 01/01/08 EACH OCCURRENCE $1 00O 000 DPREMISES (Ea o=rrance) AMAGE T'0 RENTED $1 OO OOO MED EXP (Any one person) $5 000 PERSONAL 8 ADV INJURY $1 00O 000 GL-3088 (011061 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PROT X LOC PRODUCTS - COMPIOP AGG $1 000 000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON-OWNEDAUTOS CAP3509264 01/ -. 7 * CITY (A RISK (i �.*; [} (� '. {, ,y.. 2007 PORT COT. 'IAN.;(31 .' ; P.QMBINED SINGLE LIMIT aaccident) $1,000,000 X BODILYINJURY (Per person) $ X BODILY INJURY (Per accident) $ X )TJS, PRdPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE RDEDUCTIBLE X RETFNTION $ 10,000 CUP2579804 01/01/07 01/01/08 EACH OCCURRENCE s1 OOO O00 AGGREGATE $1 OOO 000 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 3114522 10101106 10/01107 X WDRYC STATU- I OTH- EEL E.L. EACH ACCIDENT $1 OOO OOO E.L. DISEASE - EA EMPLOYEE $1 00O 000 E.L. DISEASE - POLICY LIMIT $1 00O 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / 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 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'An* DAYS WRITTEN :E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL W NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR At;UKU Z, (ZUUI/UC) 1 Of 3 #M517014 8CMAR 0 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. AGORD 25S (2001/08) 2 of 3 #M517014 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 AMS 25.3 (2001/08) 3 of 3 #M517014