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HomeMy WebLinkAbout389648 A-1 CHIPSEAL COMPANY - INSURANCE CERTIFICATE (4)Client#:53076 8A1CHIPS ACORD,.. CERTIFICATE OF LIABILITY INSURANCE 04/10/o$°'YYYY' 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 600N ' Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Mountain States Insurance Group 5900 A-1 Chipseal Company INSURERB'. Pinnacol Assurance 41190 1935 Snowy Owl Drive - - ---- - - - Broomfield, CO 80020 INSURER C -- ---- - ---- ---- I ---- -- uvsuRER 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 DD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION _DATE IMMIDDIYV LIMITS A GENERAL LIABILITY CPP010666203 10/01/07 10/01/08 EACH OCCURRENCE $1,000000 _ DAMAGETO RENTED PREMISES Gj_a oc en CA " +10W0DOQ _. X COMMERCIAL GENERAL LIABILITY v .... CLAIMS MADE IJI OCCUR ME_D EXP (Any one person) _ — _ - &10 QQQ X UND24704/02 PERSONAL &ADV INJURY $1 QQQ QQQ GENERAL AGGREGATE t $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS COMP/OP AGG s2000000 POLICY X PRO- JECr LOC A AUTOMOBILE X LIABILITY ANY AUTO BAP0107666203 10/01/07 10/01/08 COMBINED SINGLE LIMIT (Eaaccidem) 51,000,000 BODILY INJURY (Per person) S ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS NONOWNEDAUTOS BODILY INJURY (Per accldelit)derri) $ X PROPERTY DAMAGE (Per accidenQ GARAGE LIABILITY AD 10 ONLY - EA ACCIDENT S Ol'HFR THAN EA ACC S ANY AUTO S AN OONLY'. AG G A EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE UMB010666203 10/01/07 10/01/08 EACII OCCURRENCE $$ 00D 000 AGGREGATE s81000.000 5 5 IDEDUCTIBLE X RETENTION .$ 10000 S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 4055760 10/01/07 10/01/08 X' OFIR RYI MITS Of V II N E.L. EACH ACCIDENT $500,000 ANY PROPRIET012IPARTNER/EXECUTIVE E.L. DISEASE -EA EMPLOYEE 5500,000 OFFICER/MEMBER EXCLUDED? If yes, describe antler Officers Included EL. DISEASE POLICY LIMIT 55QQ,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Project Description: 6054 Asphalt Slurry Seal Project 2008 The following are Additional Insureds as respects General Liability and Umbrella Liability only if required by written contract (See Attached Descriptions) City of Fort Collins 300 La Porte Fort Collins, CO 80522 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _."301 DAYSWRITTEN E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL ',E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR UTHORIZED Ma VMU co (<vu Nubl 1 of 3 #S580462/M553767 SPRAT © 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. '-v„ , 4 OT.5 4bbbV4U/M553751 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 l2n01/nR1 4 ..f � �ecflnncornneeo�c� SECTION li - WHO IS AN INSURED I. 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 venturo 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 an 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 pf their,em,nleym pi, byu_i _yo,ncluding_tendering_nrstaid..in_an. smergency.—However, none of these.empl'oyees 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 oe-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 ('()(a) above; (c) For which there is any obligation to share damages, withor repay someone else who must pay. .damages because of the Injury describecf1 Paragraph (1)ia) or {p) 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, "volunteer 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 mana 'v r. . 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 yo-u die, but only with respect to duties as such. That representative will have all your rights and dunes under this Coverage Part, S. With respect to "mobile equipment" registered in your name under any motor vehicle registration law,, any parson 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 or 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 t,. .cnrlpe.ty-•d.�.m�.gc^r' o p. opt y.^ is - b'y-, rcntsd• O, In ti7e cha[ye ui Gr ucuupied b you ar tine 'emplover of any person who is an insured' under this provision. UND 247 04 02 Page 9 of '16 a. Coverage under this provision Is Warded only until the 18oth day aftar you acquire or form the organization, of the and of the policy pariod, whichever is earlier; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired of formed the organization; and c. Coverage 6 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 G. 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'produots". No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liabili y company that is_no shown as a Named jnsured_in :rite -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 of the number of: a. Insureds; b. Claims made or "suits" brought; or o. Persons or organizations making claims or bringing "suits", d. Parsons or, organizations included by virtue of written contract, agreement or permit. Their limits of Insurance 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 Cavarage B. 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 Limit is the most we will pay under Coverage B 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. bamages 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 "oropercy 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