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HomeMy WebLinkAboutLeft Hand Excavating - INSURANCE CERTIFICATE (2)ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(M12/11/08M/DDIYVYY) 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 Suite BOON ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIL # Left Hand Excavating Doug &Mimi Lyle 7733 IN 73rd Street INSURER A: Mountain States Insurance Group 5900 INSURERB: Pinnacol Assurance 41190 INSURER OneBeacon American Insurance Compan ---- 120621 -'— INSURER D' -- Longmont, CO 80503 INSURER E: VVVCRMUCJ 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 OD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE ATE MM DD POLICY EXPIRATION D MM DDIYY LIMITS A GENERAL LIABILITY CPP007374808 11/17/08 11/17/09 EACH OCCURRENCE $1000000 X DAMAGE TO RENTED $1 OO DOO COMMERCIAL GENERAL LIABILITY CLAIMS MADE aOCCUR MED EXP(Any one person) $10000 PERSONAL & ADV INJURY $1 OOQOOO X AI#UND24702/08 GENERAL AGGREGATE $2 OOO O00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2000000 POLICY a PRCO� LOC A AUTOMOBILE LIABILITY BAP007374808 11/17/08 11/17/09 X ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIREDAUTOS X BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGO A EXCESS/UMBRELLA LIABILITY UMB007374808 11/17/08 11/17/09 EACH OCCURRENCE_ $1 QQQ QQQ X OCCUR F—ICLAIMS MADE AGGREGATE $1 QQQ 000 $ DEDUCTIBLE X RETENTION $ 1Q 000 $ B WORKERS COMPENSATION AND 1663960 01/01/09 01/01/10 X WC STATU- OTH- EMPLOVERS' LIABILITY E.L. EACH ACCIDENT $500000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE s500,000 It yes, describe under E, L. DISEASE -POLICY LIMIT $500,000 SPECIAL PROVISIONS be. C OTHER Inst Floater 7900067540000 11/17/08 11/17/09 $250,000 Jobsite $50,000 Transit/Storage $1,000. Deductible DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Project Description: Right of Way Contractor's License The following are Additional Insureds as respects General Liability only to the extent coverage might apply according to the policy terms, (See Attached Descriptions) City of Fort Collins P O Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ^��^� 1­"u-/ T OT a rEM07a4U/ 8NPER 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 (2001/08) 2 of 3 #M615407 DESCRIPTIONS (Continued from Page 1) 1 conditions and exclusions. Consult the policy to determine extent of coverage. This Certificate confers no rights on the Certificate Holder. Additional Insureds: City of Fort Collins The General Liability 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 #M615407 7. All interest on the -Full amount of any judgment that accrues after entry of the judgment and before we have paid, offered to pay, or deposited in court the part of the judgment that is within the applicable limit of insurance. These.payments will not reduce the limits of insurance. SECTION II - WHO IS AN INSURED 1. 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 venture 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. of their employment by you, including rendering first aid in an emergency. However, none of these employees 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 co -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-emplcyee as a consequence of Paragraph (1)(a) above; (c) For which there :is any obligation to share damages with or repay someone else who must pay 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 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 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'all your rights and duties under this Coverage Part. 3. With respect to "mobile equipment" registered in your name under any motor vehicle registration law, any person 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 b. "Property damage" to property owned by, rented to, in the charge of or occupied by you or the employer of any person who is an insured under this provision. UND 247 02 08 Page 9 of 16 4. Any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership or majority interest, will qualify 'as a Named Insured If there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 1 BOth day after you acquire or form the organization or . the and of the policy period, whichever is earlier; b, Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" resulting from an offense committed before you acquired or formed the organization. 5. 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 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 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 products". No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in 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 of the 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, 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 Coverage B. l 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 t. 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 S. 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 S. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property 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 02 08 Page 10 of 16