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Home My WebLink AboutTLM CONSTRUCTORS INC - INSURANCE CERTIFICATEL.nenru: Z-I T i T IRR I LW1WPrr'74 ACORD,. OF LIABILITY INSURANCE ,CERTIFICATE 09124/05°""'"' 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 INSURER A: Travelers Indemnity Company 25658 TLM Constructors, Inc. P. O. Box 505 Swink, CO 81077 INSURER B: Pinnacol Assurance 10780 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEPOLIC(MMIDDYYJ POLICY DATE EXPIRATION LIMITS A GENERAL LIABILITY C07843B76ATIA05 07/01/05 07/01/06 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES (F cm. $300 OOO CLAIMS MADE O OCCUR MED EXP (Any one person) $5 OOO PERSONAL & ADV INJURY $1 000 000 AI# CG D2 46 (10/02) GENERAL AGGREGATE $2 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 17 POLICY PRCT X LOC X A AUTOMOBILE LIABILITY ANY AUTO 8107843B76ATIL05 07/01/05 07/01/06 COMBINED SINGLE LIMIT (Ea accident) $1 000,000 r X X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULEDAUTOS X X BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED AUTOS X X PROPERTY DAMAGE (Per accident) $ Ltd. Pollution GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY CUP7843B76ATIL05 07/01/05 07/01/06 EACH OCCURRENCE s2,000,000 X OCCUR CLAIMS MADE AGGREGATE s2,000,000 $ FDEDUCTIBLE $ X RETENTION $ 10 000 B WORKERS COMPENSATION AND 4058086 10101105 1 O/O7/O6 X I TWORYSLIMIT OTH- EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $500OOO E.L. DISEASE - EA EMPLOYEE $500000 OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project Description: Right of Way License The following are Additional Insureds as respects General Liability only If required by written contract and coverage applies only as respects (See Attached Descriptions) City of Ft. Collins 281 North College Ave. PO Box 580 Ft. Collins, CO 80522-0580 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL zn* DAYS WRITTEN :E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IE NO OSUGA'nON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25 (2001108) 1 of 3 #S265886/M265879 MAS 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 25S (2001/08) 2 of 3 #S265886/M265879 DESCRIPTIONS (Continued from Page 1) work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. Additional Insureds: City of Ft. Collins 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 AMS 25.3 (2001/O8) 3 of 3 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY— CONTRACTORS COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended c) This insurance does not apply to "bodily in- to include any person or organization you are re- jury" or "property damage" caused by "your quired to include as an additional insured on this work" included in the "products -completed policy by a written contract or written agreement operations hazard" unless you are required to in effect during this policy period and signed and provide such coverage for the additional in - executed by you prior to the loss for which cover- sured by a written contract or written agree - age is sought. The person or organization does ment in effect during this policy period and not qualify as an additional insured with respect to signed and executed by you prior to the loss the independent acts or omissions of such person for which coverage is sought and then only or organization. The person or organization is for the period of time required by such con - only an additional insured with respect to liability tract or agreement and in no event beyond caused by "your work" for that additional insured. the expiration date of the policy. 2. The insurance provided to the additional insured 3. Subpart (1)(a) of the Pollution exclusion under is limited as follows: Paragraph 2., Exclusions of Bodily Injury and a) In the event that the limits of liability stated in Property Damage Liability Coverage (Section I — the policy exceed the limits of liability required Coverages) does not apply to you if the "bodily — by a written contract or written agreement in injury" or "property damage" arises out of "your �= effect during this policy period and signed and work" performed on premises which are owned or executed by you prior to the loss for which rented by the additional insured at the time "your coverage is sought, the insurance provided work" is performed. �— by this endorsement shall be limited to the 4. Any coverage provided by this endorsement to an limits of liability required by such contract or additional insured shall be excess over any other �= agreement. This endorsement shall not in- valid and collectible insurance available to the o= crease the limits stated in Section III — LIMITS additional insured whether primary, excess, con- o= OF INSURANCE. tingent or on any other basis unless a written ^= b) The insurance provided to the additional in- contract or written agreement in effect during this sured does not apply to "bodily injury", "prop- policy period and signed and executed by you erty damage", "personal injury" or "advertising prior to the loss for which coverage is sought ^� injury" arising out of an architect's, engineer's specifically requires that this insurance apply on a �= or surveyor's rendering of or failure to render primary or non-contributory basis. When this in - any professional services including: �= surance is primary and there is other insurance �= I. The preparing, approving or failing to available to the additional insured from any prepare or approve maps, shop drawings, source, we will share with that other insurance by o= the method described in the policy. o= opinions, reports, surveys, field orders, change orders, or drawings and specifi- S. As a condition of coverage, each additional cations; and insured must: u- II. Supervisory or inspection activities per- a.) Give us prompt written notice of any "occur - formed as part of any related architectural rence" or offense which may result in a claim or engineering activities. and prompt written notice of "suit". CG D2 46 10 02 Copyright, The Travelers Indemnity Company, 2002 Page 1 of 2 009039