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Home My WebLink About168787 GOLDEN TRIANGLE CONSTRUCTION INC - INSURANCE CERTIFICATE (16)Sent By: OTC; 3037768525; Sep-29-03 10:41AM; Page 2 Clientfi• 0385 UVLUI KI ACORD,a CERTIFICATE OF LIABILITY INSURANCE o61161oa' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH of Colorado py ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 720 S. Colorado Blvd Site PH N L/ rJ N17 QOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.Q_ Box 469026 LTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver, CO 80246-0026 INSURED Golden Triangle Construction, Inc. 700 Weaver Park Rd. Longmont, CO 80501 CCIVRRAGES INSURERS AFFORDING COVERAGE NAIC # INSURER A- CNA Insurance Companies 3119d INSURER B: Pinnacol Assurance INSURER C: INSURER D: INSURER E TI IE POLICIES OF INSURANCE LISTED BELOW K1109EN 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMIT$ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR N6149 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY E uP�Om LIMIT9 A GENERAL LIABILITY TCP2022866738 12/31102 12/31/03 EACHOCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR DAMAGE TO RENTEDPR�NISrS $SOO OOD $5 000 MF.D EXP (Arty a a pars PERSONAL tAOVINJURY S1 000 000 GENERAL AGGREGATE s2,000,0100 GENT AGGREGATE LIMIT APPLIES PER: PRODUC IS - OLIMI'/OP AGO s2000000 rn POLICY 51 JCC- X LOG A AUTOMOBILE LIABILITY ANY AUTO RUA2022866741 12131/02 12/31/03 COMBINED SINGLE LIMIT (EeAddidml) $1,000,D00 X BODILYINJURY (Per person) $ AI I. OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS AUTOS X BODILY INJURY (P(r erN,wm) $ X TNON•OMJEO PROPERTY DAMAGE (Pe, anEkwid) S GARAGE LIABILITY w. AUTO ONLY - EA ACCIDENT $ OTHER WAN EAACC AUTO ONLY: AGO $ ANY AUTO $ A EXCESSIUMBRELLA LIABILITY :X] OCCUR CLAIMS MADE CUP2022866786 12/31102 12131103 EACH OCCURRENCE $2 000 000 AGGREGATE $2 00O 000 I a DEDUCTIBLE X REVENTION $ 10000 Is B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PHOPH10ORdPARTNER,EXECUTNE OFFICE•R/MEMBEREXCLUDEDI If yes, °BeC°°e u"°w $PF,,,IAL PROVISIONS below 4013024 07/01/03 1101011104 X WC TORY LIMITS OTH- -" E.L. EACH ACC03ENT $1 00D 000 E.L. DISEASE - EA EMPLOYEE $1,000.000 E.L. DI8EASE-POLICY LIMIT 00000a $1, , DTHCA DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Gardens on Spring Creek City of Fort Collins, Colorado, Engineer, Engineer's Consultants and any other persona or entitles Identified in contract supplementary conditions are Additional Insureds as respects to General Liability, Auto (See Attached Descriptions) City of Fort Collins, Colorado 215 North Mason Street Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUINGINSURER WILL ENOEAVORTD MAIL —30-- DAYSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 $HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR12ED eEPRESENTATIVE 25 (2001/08)1 of 3 #1111165057 MGP 0 ACORD CORPORATION 1988 Sent By: OTC; 3037766525; Sep-29-03 10:41AM; Page 3/6 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 endorsernent(s), DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insumr(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon. ACORD 25-512001103) 2 of 3 9MIS5057 Sent By: GTC; 3037766525; Sep-29-03 10:42AM; Page 416 DESCRIPTIONS (Continued from Page 1) Liability and Umbrella Liability only If required by written contract and coverage applies only as respects ongoing operations performed by Insured for the Certificate Holder. All coverage terms, conditions and exclusions of the policy apply. Cancellation Clause & Materialy Altered aMended: will mail 30 days written notice to the Certificate Holder. 10 days notice will be given for non-payment of premium. Sent By: OTC; 3037766525; Sep-29-03 10:42AM; Page 5/6 Gotaen.Triangle `onscruction, lnc. Policy #TCP2022866738 G-14Q331-A CNA (Ed. 01/01) IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL. INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C.1.OF THIS ENDORSEMENT FOR THESE DUTIES. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED ENDORSEMENT WITH PRODUCTS -COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIA131LITY COVERAGE PART SCHEDULE Name of Person or Organization: Designated Project: (Coverage under this endorsement Is not affected by an entry or lack of entry In the Schedule above.) A. WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization, Including any person or organization shown in the schedule above, (called additional insured) whom you are required to add as an additional insured on this policy under a written contract or written agreement; but the written contract or written agreement must be: 1. Currently in effect or becoming effective during the term of this policy; and 2. Executed prior to the "bodily injury," "property damage,' or `personal and advertising injury". B. The insurance provided to the additional insured is limited as follows: 1. That person or organization is an additional insured solely for liability due to your negligence specifically resulting from "your work" for the add-rtional insured which is the subject of the written contract or written agreement. No coverage applies to liability resulting from the sole negligence of the additional insured. 2. The Limits of Insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These Limits of Insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations. 3. The coverage provided to the. additional insured by this endorsement and paragraph f. of the definition of "insured contract" under DEFINITIONS (Section V) do not apply to "bodily injury" or "property damage" arising out of the "products -completed operations hazard' unless required by the written contract or written agreement. 4. The insurance provided to the additional insured does not apply to `bodily injury,' "property damage; or "personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services including: 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. C. As respects the coverage provided under this endorsement, SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS are amended as follows: G-140331-A (Ed. 01101) Page 1 of 2 Sent By: GTC; 3037766525; Sep-29-03 10:42AM; Page 6/6 A 1. The following is added to the Duties In The Event of Occurrence, Offense, Claim or Suit Condition: e. An additional insured under this endorsement will as soon as practicable: (1) Give written notice of an occurrence or an offense to us which may result in a claim or "suit° under this insurance; (2) Tender the defense and indemnity of any claim or "suir to any other insurer which also has insurance for a loss we cover under this Coverage Part; and (3) Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. G-140331-A (Ed. 01/01) f. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit" from the additional insured. 2. Paragraph 4.b. of the Other Insurance Condition is deleted and replaced with the following: 4. Other Insurance b. Excess Insurance This insurance is excess over any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing. G-140331-A (Ed. 01101) Page 2 of 2