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Home My WebLink AboutTLM CONSTRUCTORS - INSURANCE CERTIFICATECliantid• 71171 TLMCONS2 ACORD. CERTIFICATE OF LIABILITY INSURANCE 09/22/li4 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH of Colorado 720 S. Colorado Blvd Ste 600-N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 INSURER A: Zurich -American Ins. Co. 16535 TLM Constructors, Inc. INSURER B: Amercan Guarantee Insurance 35521 P. O. Box 505 Swink, CO 81077 INSURER C: Pinnacol Assurance 10780 INSURER D: INSURER E: COVFRAGFS 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 LTR ADD'LPOLICY NSR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE MMIDD POLICY EXPIRATION YY DATE MM/DDI LIMITS A GENERAL LIABILITY CP03757882 07/01/04 07/01/05 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED"MI $300DDD CLAIMS MADE Ex-J OCCUR MED EXP (Any one person) $1 D 000 PERSONAL B ADV INJURY $1 DDD 000 X Blkt Addl lnsrd X Ltd Pollution GENERAL AGGREGATE $2 00D 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2 00O 000 POLICY X PRO- JECT X LOC A AUTOMOBILE LIABILITY ANY AUTO CP03757882 07/01/04 07/01/05 COMBINED SINGLE LIMIT (Ea accident) $1,ODD,DDD X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNEDAUTOS X X PROPERTY DAMAGE (Per accident) $ Ltd Pollution GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESSIUMBRELLA LIABILITY AUC3757883 07/01/04 07/01/05 EACH OCCURRENCE s2,000,000 X OCCUR CLAIMS MADE AGGREGATE s2,000,000 $ DEDUCTIBLE $ RETENTION $ C WORKERS COMPENSATION AND 4058086 10/01/04 10/01/05 TATUil X TWOCSRYLIMIT OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $SOO,000 E.L. DISEASE - EA EMPLOYEE $500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS REVISED CERTIFICATE: All previously issued certificates are null and void for this Certificate Holder/Project. Project Description: SH 287 & Lake Street Median Improvements Bid Number: 5866 (See Attached Descriptions) City of Ft. Collins 215 N. Mason Street, 2nd Floor Fort Collins, CO 80522 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In* DAYS WRITTEN :E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL iE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVE 0, ACORD 25 (2001103) 1 of 3 #M223970 HXK O 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 #M223970 DESCRIPTIONS (Continued from Page 1) The following are Additional Insureds as respects General Liability only if required by written contract 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. Additional Insureds: The City of Ft. Collins, the Engineer, the Engineer's Consultants and their officers and employees and any other persons or entities identified in the 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 (2001/08) 3 of 3 #M223970 INSURM: TLM Constructors, Inc. Additional Insured — Automatic - Owners, Lessees Or Contractors - Broad Form 0 ZURICH Policy No. I Eff. Date of Pot. Exp. Date of Pol. BE Date of End. Producer Add'1. Prem Retum Prem. CP03757882 07/01/04 07/01/05 $ $ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. _ ____B—The insurance_providedAo-additional-insureds-applies-only-to"bodily-injury'; "property -damage di personal-a3�advertls ing injury" covered under Section I, Coverage A, BODILY INJURY AND PROPERTY DAMAGE LIABILITY and Coverage B, PERSONAL AND ADVERTISING INJURY LIABILITY, but only if: 1. The "bodily injury" or "property damage" results from your negligence; and 2. The "bodily injury", "property damage" or "personal and advertising injury" results directly from: a. Your ongoing operations; or b. "Your work" completed as included in the "products -completed operations hazard", performed for the additional insured, which is the subject of the written contract or written agreement. C. However, regardless of the provisions of paragraphs A. and B. above: 1. We will not extend any insurance coverage to any additional insured person or organization: a. That is not provided to you in this policy; or b. That is any broader coverage than you are required to provide to the additional insured person or organization in the written contract or written agreement; and 2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of a. The Limits of Insurance provided to you in this policy; or b. The Limits of Insurance you are required to provide in the written contract or written agreement. D. The insurance provided to the additional insured person or organization does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" that results solely from negligence of the addi- tional insured; or U-GL-I175-A CW (9103) Includes coovriahted material of Insurance Services Office. Inc, with its eermissien. Page 1 of 2