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HomeMy WebLinkAbout389648 A-1 CHIPSEAL COMPANY - INSURANCE CERTIFICATE (2)Client#: 20936 AICHIPS ACORDTM CERTIFICATE OF LIABILITY INSURANCE 099/26/06D`""" PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH of Colorado ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 720 S. Colorado Blvd Ste 600-N HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 469025 Denver, CO 80246-9025 INSURERS AFFORDING COVERAGE NAIC # INSURED A-1 Chipseal Company 1935 Snowy Owl Drive Broomfield, CO 80020 INSURER A: Mountain States Insurance Grp 5900 INSURER B: Pinnacol Assurance 10780 INSURER C: INSURER D: INSURER E: :OVERAGES 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 NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD POLICY EXPIRATION DATE (MM[DDIYYI LIMITS A GENERAL LIABILITY CPP0106662 10/01/06 10/01/07 EACH OCCURRENCE $1 000 0OO X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 51OCCUR DAMAGETOREMEDnoa, $100000 MED EXP (Any one Person) $10 000 PERSONAL & ADV INJURY $1 000000 X Al: UND247 ONO2 GENERAL AGGREGATE $2 00O OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2000000 POLICYER PRO LOC A AUTOMOBILE LIABILITY ANY AUTO BAP0106662 /J}�lO6., _ c ei( 10/01/07 COMBINED SINGLE LIMIT (Eaaaident) $1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS �id,�J„ HIRED AUTOS NON -OWNED AUTOS C RISK 21 U/ N ( ' MAN/{�F 1 00 LLINg X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE UMB0106662 10/01/06 10/01/07 EACH OCCURRENCE O00 000 AGGREGATE Es5000 000 XIDEDUCTIBLE RETENTION $ 10 000 $ B WORKERS COMPENSATION AND EMPLOVERS' LIABILITYDRY ANY PROPRIETOR/PARTNER/EXECUTIVE 4055760 Owners/Officers 10/01/06 10/01/07 X STATU- oTH- E.L. EACH ACCIDENT $5OO OOO OFFICER/MEMBER EXCLUDED? If yes describe under SPECIAL PROVISIONS below Included E. L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE - POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Project Description: 5967 Asphalt Slurry Seal Project 2006 The following are Additional Insureds as respects General Liability and Umbrella Liability (Following Form) only if required by written contract (See Attached Descriptions) City of Fort Collins 300 La Porte Fort Collins, CO 80522 LD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ 0*- DAYS WRITTEN :E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL iE NO OBLIGATION OR LIABILITY OFANY KIN61UPON 1HEINSURER, ITS AGENTS OR ,_I UI 43 FFinaUDOTa • , CHM-, ) 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. annwn oe_c ionn4ino. DESCRIPTIONS (Continued from Page 1) and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. The following are Additional Insureds on the Automobile Liability only to the extent they meet the definition of an insured in the policy, which provides in pertinent part that an insured includes anyone liable for the conduct of another insured but only to the extent of that liability. All coverage terms, conditions and exclusions of the policy apply. Consult the policy to determine the extent of coverage, if any. Additional Insureds: City of Fort Collins The General Liability coverage is Primary per the policy terms & conditions only if required by written contract. The Workers' Compensation policy includes a Waiver of Subrogation in favor of the Additional Insureds only if required by written contract. 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 -- ;r;Lere' U.",(ae ';UN LIr{Zt%`.M Lai oily JUUtjiilaliL Lilat at.Vluoa alto; a11Lly U1 Lilt$ JUUa111t$llL a11U Gt$IUrt3 we nave pale, offered to pay, or deposited in court the part of the judgment that is within the applicable limit of insurance. These payments will not reduce the limits of insurance. ECTION If - WHO 1S AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. c. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers, d. An organization other than a partnership, joint venturd or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. e. A trust, you are ant insured. Your trustees are also insureds, but only with respect to their duties as trustees. 2. Each of the following is also an insured: a. Your "volunteer workers" only while performing duties related to the conduct of your business, or your employees, other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for . acts _within the scope of tFte(r_emp).oymegl by,-yquF_inoluding_teitderiog_flr_st. aid -in -an. emergency....However,. none of these employees or "volunteer workers" are insureds for. (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), a co -employee while in the course of his or her employment or. performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co -employee as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages wltb or. repay Aolneonq else who must pay. damages because of the Injury descrlbidiri Paragraph (J)(a) or (6) above. (2) "Property damage" to property: (a)' Owned, occupied or used by; (b) Rented to, In the care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your employees, llvolunteer workers", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Any person (other than your employee or "volunteer worker"), or any organization while acting as your real estate manager. c. Any person or organization having proper temporary custody of your property if you die, but only: (1) With respect to liability resulting from the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That representative v011 have all your rights and duties under this Coverage Part, 3. With respect to "mobile equipment" registered in your name under any motor vehicle registration law, any person is an insured while driving such equipment along a public highway with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability resulting from the operation of the equipment, and only if no other insurance of any kind is available to that person cr organization for this liability. However, no person or organization is an insured with respect to: a. "Bodily injury" to a co -employee of the person driving the equipment; or .. L`. UPrCpert� •dernaga" tv•p"i'C7p2rt'y'vvJiicd' byi icil Lad' to, lit the Lhamue 014-Or OCCUP16d by %/au or the'em Pldyer of any person who is an insured under this provision. - UND 2-47 04 02 Page 9 of 'Is 4. Any organization you newly acquire or form, other than a partnership or joint venture, and' over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: e. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or, formed the organization; and c. Coverage R does not apply to "personal and advertising injury" resulting from an offense committed before you acquired or formed the organization. Any person or organization to whom or to which you are obligated by virtue of a written contract, agreement or permit to provide such insurance as afforded by this policy is an insured, but only with respect to liability resulting from: a. "Your work" for that insured by you; b. Permits issued by state or political subdivisions' for operations performed by you; or c. Premises you own, rent, occupy or use. This provision does not apply unless the written contract or agreement has been executed, or the permit has been issued, prior to the "bodily injury", "property damage", or "personal and advertising injury". This provision does not apply to any person or organization for "your products". The ADDITIONAL INSURED - VENDORS endorsement must be attached to the policy to provide coverage for "your'products". No person or organization is an Insured with respect to the conduct of any current or past partnership, joint venture or limited iiab!:IIV.comMny that is noL shgwp as a Np.med lasipred-la the_Deglarations SECTION III - LIMITS OF INSURANCE 1. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought, or c. Persona or organizations making claims or bringing "suits". d. Persons or organizations,inciuded by virtue of written contract, agreement or permit Their Umits of Insuranca shall be the limit required by that written contract, agreement or permit or the Limits of Insurance of this policy, whichever is less, and shall not be in addition to the Limits of Insurance shown in the Declarations. 2. The General Aggregate Limit is'the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage,A, except damages because of "bodily injury" or "property damage" Included in the "products -completed operations hazard"; and c. Damages under Coverage S. 3: The Products -Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products -completed operations hazard". 4. Subject to 2. above, the Personal and Advertising .Injury unit is the most we will pay under Coverage 8 for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization. 5. Subject to 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Qamages under Coverage A; and b. Medical expenses under Coverage C because of all "bodily injury" and "property damage" resulting from any one "occurrence". 6. Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. UND 247 04 02 Page 10 of 16