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HomeMy WebLinkAboutMOUNTAIN CONSTRUCTORS - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE 06/28/2o 6 PRODUCER (303)824-6600 FAX (303)370-0118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Moody Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPONTHE CERTIFICATE 3773 Cherry Creek North Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 800 Denver, CO 80209-3804 INSURERS AFFORDING COVERAGE NAIC # INSURED Mountain Constructors, Inc. INSURERA: Bituminous Insurance Companies PO Box 405 INSURER B: P i nnaco I Assurance Platteville, CO 80651 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 AQVI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CLP3216240 07/28/2005 07/28/2006 EACH OCCURRENCE $ 1,000,00 X COMMERCALGENERALLIABILITY DAMAGE TOREMED $ 100,000 CLAIMS MADE � OCCUR MED EXP (Any one person) $ 5, QQ A PERSONAL BADV INJURY $ 1 , 000, QQ GENERAL AGGREGATE $ 2, 000, QQ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2, 000, 00 X POLICY PRO- LOC JECT AUTOMOBILE X LIABILITY ANY AUTO CAP ,� /� f.,QO 06 COMBINED SINGLE LIMIT (Ea accident)$ 1,000,00 BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULEDAUIGS �.14`' .ggd �� 20116 pp BODILY INJURY (Peraoddenl) $ HIRED AUTOS NON-OWNEDAUTOS CITY RISK l: F ojt i� MANAGE LLINS ENT PROPERTY DAMAGE (Per acddenq $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO $ EXCES&UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000 X OCCUR CLAIMS MADE CUP2576738 07/28/2005 07/28/2006 AGGREGATE $ 2,000,00 A $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND 3027994 07/01/2006 07/01/2007 X WcsTATU- I OTH- FIR B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Leased/Borrowed Equipment CLP3216240 07/28/2005 07/28/2006 $250,000 per occurrence $1,000 deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS roj ect: 5932 Mason Street/Harmony Road/Spring Creek Bike/Pedestrian Tra i I ity of Fort Collins is named additional insured with respect to general liability per attached orm GL4276 9/03. 0 day notice of cancellation applies to non-payment of premium CERTIFICATE HOLDER CANCELLATION 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, --City of Fort Collins BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 300 Laporte Ave. OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /I ' Fort Collins, CO 80522 • . - Charlene Navarra, ACSR/CHAN,^`� ^" ACORD 25 (2001/08) ©ACORD CORPORATION 1988 (2) The additional insured shall not take any action m walve or limn such other coverage available to It. e. This insurance does not apply to: a. 'Bodily Injury' property demage' or "personal and advertising Injury' occurring after: (1) All work on the project (other than eervlea, maintenance, or repairs) to be performed by or on behag of the additional Insured(*) has been completed; or (1h That portion of your work' out of which fhe Injury or damage aches has been put to he Intended tee by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a pan of the same project. b. 'Bodly Injury' property damage' or 'personal and advartsing Injury' rasuhing from any act or omission of the additional Insured(*) or any of their employees, other than the general supervision of work performed for the additions) Insureds) by you. c. 'Bodily Injury" property dsmage' 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 'eddly Injury,"'properly 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 behah, but only with respect to either or both of the following operations; (a) Providing engineering, arohkecwral or surveying services to others In the Insureds capacity as an engineer, architect or surveyor, and op) Providing, or hiring Independent professionals to provide, engineering, architectural or surveying services in connection with work the insured performs. (2) Subject to paragraph (8) below, professional services Include (a) The preparing, approving or hailing to prepare or approve maps, shop drawings, opinion*, report:, surveys, field orders, change orders, or drawings and specifications; and (b) Supervisory or Inspection activities Worried as part of any related architectural or engineering activities, but does not Include the general supervision of your operations on such project. (8) Professional services do not kwlyde 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: 'OwW means a parson or organization who has ownership in the project premises, designated in your written contract or written agreement, at which you are performing operations at. OL♦276 (CQM3) -2- -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. "Construction Manager' means a person or organization designated as "consinrction 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 a 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 a written agreement executed prior to any loss that this insurance will be primary. However, any Insurance specilloally purchased for a designated pro)ect(s), Including but not limited to specific additional insured coverage, owners contractors protective coverage, etc., will be primary with this Insurance being excess. This Insurance will be noncontributory only If you have so agreed In a written contract or written agreement executed prior to any lots and this coverage is determined to be primary. GL4276 (09103) -3- No Text 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 25 (2001108) CITY" Of FOR I' COLLINS RISK MANAGEMENT THIS E71pOHBEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ADDITIONAL INSURED ENDORSEMENT This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. SECTION 1- WHO IS AN !INSURED la amended to Inicko a: Any "owner', "contractor", 'construction manage", "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 organlzatlonls) 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 trom: A. Your ongoing operations for the additional Insured(s), or S. 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 Forth, the following additional provisions apply to limit that coverage: 1. We will have no duty to defend the addhional insured against any "suit' seeking damages for 'bodily Injury; 'property damage' or'parsonal and advertising Injury,' until we receive written notice from the additional insured requesting that we defend it in the'suh.' 2. The Limits of Insurance applicable to the additional insureds under this endorsement are those specified in the written contract or agreement requiring this coverage, or as stated in SECTION M - LIMIT'S OF INSURANCE of the COMMERCIAL GENERAL UA13LM COVERAGE FORM, whichever are fens. These Limits of Insurance are inclusive of and not in addition to the Limits of Insurance described in SECTION ■ of that torn. A 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'occurrenoe' or offense took place; M The names and addresses of any injured persons and witnesses; and (S) The nature and location of any injury or damage ansing out of the "occurrence' or offense. lo. 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 h was received. Q Give written notice of such claim or'suil,' including a demand for defense and indemnity, to any other insurer who had coverage for The claim or'suh' under its policy(les), either at the time of, or at any time subsequent to the occurrence of the 'bodily injury," 'property damage' andfor 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 GL-4216 (09I03) -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: IL '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 or on behalf of the additional Insured(s) has been completed; or (2) That portion of 'your work' out of which the Injury or damage aft" has been out to Its Intended use by any person or organization other than another contractor or subcontractor engaged In partormbrp operations for a principal as a part of the same project. It. 'Bodily Injury' 'propery, damage' or 'personal and advertising Injury' resulting from any act or omission of the additional Insured(*) or any of their employees, other than the general supervision of work performed for the additional insureds) by you. G. '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. 'Body injury,"'property damage" or'pesonal and advertising injury': (1) Arising out of the randedng or failure to render any professional services by any Insured, or on their behalf, but only with respect to abhor or both of the following operations; (a) Providing engineering, architectural or surveying services to others In the insurWo 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 "micas Include: (a) The preparing, approving or falling to prepare or approve maps, shop drawings, opinions, reports, survays, field orders, change orders, or drawings and specifications; and W 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 "micas within construction means, memode, 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 oryanizebon who has ownership in the project premises, designated In your written contract or written agreement, at which you are perbnning operations at. OL-4276 (01103) -2- "contractor' means a person or organization with whom you have agreed in a written contract or written agreement to pariorm operations 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 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($) whether primary, excess, contingent or on arty 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 specific additional insured coverage, owners contractors protective coverage, etc., will be primary with this insurance being excess. This Insurance will be noncontributory only it you have so agreed In a written contract or written agreement executed prior to any loss and this coverage is determined to be primary. GL-4276 (09103) 3. No Text ACORD,a CERTIFICATE OF LIABILITY INSURANCE 06/28/20 6 PRODUCER (303)824-6600 FAX (303)370-0118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Moody Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3773 Cherry Creek North Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 800 Denver, CO 80209-3804 INSURERS AFFORDING COVERAGE NAIC # INSURED Mountain Constructors, Inc. INSURER A: Bituminous Insurance Companies PO Box 405 INSURERS: Pinnacol Assurance Platteville, CO 80651 INSURER O. INSURER D: INSURER E: rnveoAr_C v 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. INSftDihTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CLP3216240 07/28/2005 07/28/2006 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES (F,$ 100,0001 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 1XI OCCUR MED EXP (Any me person) $ 5, 00 PERSONAL BADV INJURY $ 1,000,00( A ff, GENERAL AGGREGATE $ 2,000,00C GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2, 000, 00 X POLICY PRO El LOC JECT AUTOMOBILE X LIABILITY ANY AUTO CAP3215536 yN-'�i';"'��i , 07/28/2005 T� 07/28/2006 COMBINED SINGLE LIMIT (Ea accident)$ 1,000,000 BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS „l��q* OOp �Ci ,� �.% /_ODU BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ ff (�' � •," t_y I' f 7u ii TT1 )� � �OLL GARAGE LIABILITY f s K 1 ) AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,00 X OCCUR CLAIMS MADE CUP2576738 07/28/2005 07/28/2006 AGGREGATE $ 2,000,00 $ A $ DEDUCTIBLE $ 11 RETENTION $ WORKERS COMPENSATION AND 3027994 07/01/2006 07/01/2007 X `A'C STATU- B EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 Use, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 11000,000 A Leased/Borrowed Equipment CLP3216240 07/28/2005 07/28/2006 $250,000 per occurrence $1,000 deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS roject: 5931 Mason Street/Harmony Road/Fossil Creek Bike/Pedestrian Trail ity of Fort Collins is named additional insured with respect to general liability per attached orm GL4276 9/03. 0 day notice of cancellation applies to non-payment of premium CERTIFICATE HOLDER CANCELLATION 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., --City of Fort Co I I i ns BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 300 Laporte Ave. OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �I� � Fort Col I ins, CO 80522 � Charlene Navarra, ACSR/CHAN ACORD 25 (2001/08) ©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. ACORD 25 (2001108) JUN CITY OF FOk'I- RISK MANAGL,.. ,,,, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ADDITIONAL INURED ENDORSEMENT This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. SECTION I - WHO E AN INSURED A amwtdW to malaria: Any 'owmr", '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 organlzation(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 liebilily resulting from: A. Your ongoing operators for the additional Insured(s), or 0. Acts or omissions of the addltlonal 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 a in the'sun.' Y. The Limits of Insurance applicable to the additional Insureds under this endorsement are those specified in the written contract or agreement requiring this coverage, or as stated in SECTION M - LNIRS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM, whichever are less. These Limits of Insurance are inclusive of and not in addition to the Limits of Insurance described In SECTION ■ of that form. & 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. a 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(les), either at the time of, or at any time subsequent to the occurrence of the 'bodily injury," 'properly 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 lull coverage available under that policy; and GL-4276 (09/03) -1.