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HomeMy WebLinkAbout389648 A-1 CHIPSEAL COMPANY - INSURANCE CERTIFICATE (3)ACORD- CERTIFICATE OF LIABILITY INSURANCE DY YY,I 9;271(07 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 Mountain States Insurance Group 5900 A-1 Chipseal Company INSURERS Pinnacol Assurance 10780 1935 Snowy Owl Drive INSURER C Broomfield, CO 80020 INSURER D 'SURER E COVERAGES I 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 VNTH 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 A GENERAL LIABILITY CPP010666203 10/01/07 10/01/08 X COMMERCIAL GENERALLIABILITY OLAIMS MADE X OCCUR X LIND24704/02 GEN L AGGREGATE LIMIT APPLIES PER A AUTOMOBILE LIABILITY BAP0107666203 10/01/07 10/01/08 X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON OWNED AUTOS GARAGE LIABILITY 7 ANY AUTO A I EXCESSIUMBRELLALIABILITY IUMB010666203 I10101/07 I10/01/08 X OCCUR III CLAIMS MADE HXDEDUCTIBLE RETENTION $ 10000 B WORKERS COMPENSATION AND 4055760 10/01/07 10/01/08 EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED Officers Included OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project Description 6054 Asphalt Slurry Seal Project 2007 The following are Additional Insureds as respects General Liability and Umbrella Liability only if required by written contract (See Attached Descriptions) City of Fort Coning 300 La Porte Fort Collins, CO 80522 I PERSONAL& ADV INJURY I$1.000.000 II I PROnIICT9 f.OMPIOP Acn I S9 000 nnn I I COMBINED SINGLELIMIT $1,000,OOO (Ea aamdent) BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per IcadeM) AUTO ONLY EA ACCIDENT S OTHER THAN EA ACC S AUTO ONLY ADD 5 EACH OCCURRENCE $5 DOD O00 AGGREGATE s5,000,000 5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL an« DAYS WRITTEN VOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL I IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR SEPRESENTATWES AUTHORIZED REPRESENTATIyE ACORD 25 (2001/08) 1 of 3 #M553443 8JPAE 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 ACORD 25-S (2001108) 2 of 3 #M553443 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 an 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 This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract 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 (2001108) 3 of 3 #M553443 PIECTION II - WHO IS AN INSURED . 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 v you are the sole owner. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are 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 tc conduct of your business. Your managers are insureds, but only with respect to their duties as your mana! d. An organization other than a partnership, joint venturd or limited (lability company, you are an Insured. "executive officers" and directors are insureds, but only with respect to their duties as your offices directors. Your stockholders are also insureds, but only with respect to their liability as stockholders e A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustee 2. Each of the following (s also an insured: a. Your "volunteer workers" only while performing duties related to the conduct of your business, or yoi employees, other than either your "executive officers" (if you are an organization other than a partnersHil joint venture or limited [(ability company) or your managers (if you are a limited liability company), but only if acts within the ,scope of their_ employment by -you,_ including_rendering-first aid -in -an emergency Howeve none of these employees or "volunteer workers" are insureds for. (11 "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 you are a limited liability company), a co -employee while in the course of his or her employment r performing duties related to the conduct of your business, or to your other "volunteer workers" whi 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 Paragralp (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must .damages because of the Injury described in Paragraph M(a)or (b)'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 a purpose by you, any of your employees, "volunteer workers", any partner or member (if you are 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 re 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 will have your rights and duties under this Coverage Part, 3 vVith respect to "mobile equipment" registered in your name under any motor vehicle registration law, any parso is an insured while driving such equipment along a public highway with your permission Any other person organization responsible fcr the conduct of such person is also an insured, but only with respect to liabilit resulting from the operation of the equipment, and only if no other insurance of any kind is available to that parse 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 parson driving the equipment; or b "Pro a - damp o" a, • - ,;ned by _ ct - - `--- � ` p..,^.y ^y p7Cp y .. may, i=iiic�. to, ii, the eii4[c�e GTGf uc=[-uyieG 6y you of ifle em plover O any person who is an insured under this provision UND 247 04 02 Page 9 of 16 a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organiz: 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 acquit formed the organization; and c. Coverage B does not apply to "personal and advertising injury" resulting from an offense committed you acquired or formed the organization. - Any person or organization to whom or to which you are obligated by virtue of a written contract, agreemi permit to provide such insurance as afforded by this policy is an insured, but only with respect to liability res from: is. "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 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 INSUR 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, venture or limited liabili`y_comp y. that 1s_no= shown as a Named In$uredjp the_Declarations- _ _ _ _ _ _ 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 number of: a- Insureds; b. Claims made or "suits" brought; or c, Persons or organizations making claims or bringing "suits". d. Persons or organizations included by virtue of written contract, agreement or permit. Thelr Limits of Insur shall be the limit required by that written contract, agreement or permit or the Limits of Insurance of 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 t "products -completed operations hazard"; and Damages under Coverage B. 3- The Products -Completed Operations Aggregate Limit is the most we will pay under Coverage A for dame because of "bodily injury" and "property damage" included in the "products -completed operations hazard" 4. Subject to 2. above, the Personal and Advertising Injury Limit is the most we will pay under Coverage B for tl 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. Damages 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 f damages because of "property damage" to any one oramises, while rented to you, or in the case of damage I {re, while rented to you or temporarily occupied by you wan permission of the owner. UND 247 04 02 Page 10 of 16