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HomeMy WebLinkAboutALLIANCE CONSTRUCTION - INSURANCE CERTIFICATE (2)A CORDm CERTIFICATE OF LIABILITY INSURANCE DATE (MNVDDNYYY) 12/22/2008 PRODUCER (303)824-6600 FAX: (303)370-0118 Moody Insurance Agency, Inc. 3773 Cherry Creek North Drive Suite 800 Denver CO 80209-3804 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Alliance Construction Solutions 2725 Rocky Mountain Avenue Suite 100 Loveland CO 80538 INSURER A: Travelers_ Indemnity 25658 INSURER B: Travelers Prop Cas Cc of 25674 INSURERc:Amer Guarantee Liab Ins 26247 INSURER D:Pinnacol Assurance 41190 INSURER E:Fireman Is Fund Ins Co 21873 ra ivyaITAx4 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 HAVEEN REDUCED BY PAID CLAIMS. INSR JB_INSR TYPE OF INSURANCE POLICY NUMBER DATE(MIVUDD/YPOLICY EFFECTIYEOLICY) PDATEMM/DD/YYEXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PR MI$E$1EVy-g, occurrence) $ 300, 000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [i] OCCUR DTCO0161L68AINDO9 1/1/2009 1/1/2010 MED EXP An onePerson) $ 5,000 PERSONAL 4, ADV INJURY $ 1,000,000 Blkt Additional Insured GENERALAGGREGATE $ 2,000,000 Her form CGD248 08/05 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 Attached POLICY X JE O LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ B ALL OWNED AUTOS SCHEDULED AUTOS DT810016IL68ATIL09 1/l/2009 1/1/2010 BODILY INJURY (Per accident) $ HIRED AUTOS NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHERTHAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCk RRENCE $ 10, 000, 000 X OCCUR CLAIMS MADE AGGREGATE S 10, 000, 000 5 S C DEDUCTIBLE AUC914113802 1/l/2009 1/1/2010 X RETENTION S 0 D WORKERS COMPENSATION AND - X I WC STATU OTHLIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE$ 500,000 OFFICER/MEMBER EXCLUDED? 4038468 1/1/2009 1/1/2010 If Yes, describe SPECIAL PROVISIONS below S E.L. DISEASE - POLICY LIMIT 5 500, 000 g OTHER Builders Risk MZ198473110 1/1/2009 1/1/2010 Limit 10,000,000 Deductible 25,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Ground Lease @ Fort Collins/Loveland Airport City of Fort Collins is named Additional Insured in regards to General Liability. This certificate is subject to the terms, conditions, and exclusions of the policies. A 10-day notice of cancellation will apply in the event of non-payment of premium. City of Fort Collins PO 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 ACORD 25 (2001/08) INS025(0i0o fur AUTHORIZED REPRESENTATIVE �p L Ransom, CIC, CPCU/J © ACORD CORPORATION 1988 Page 1 of COMMERCIAL GENERAL LIABILITY b) If a claim is made or "suit' is brought against the additional insured, the additional insured must: I. Immediately record the specifics of the claim or "suit' and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. cl) The additional insured must tender the de- fense and indemnity of any claim or "suit' to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to 'other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc, curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 48 08 05 , k. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) `.,..� 12i28i2009 PRODUCER (303) 824-6600 FAX: (303) 370-0118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Moody Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3773 Cherry Creek North Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 800 Denver CO 80209-3804 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Indemnity Company 25658 Alliance Construction Solutions INSURER B: Travelers Prop Cas Co of 25674 2725 Rocky Mountain Avenue INSURERC:Amer Guarantee Liab Ins Co 26247 Suite 100 INSURER D: Pinnacol Assurance 41190 Loveland CO 80538 INSURERE: rnVFRArFc 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 ADD 'L LTR IN RDA.INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE �X OCCUR DTCO0161L68AIND10 1/1/2010 1/l/2011 DAMAGE TO RENTED PREMISES (Ea occurrence $ 300,000 MED EXP (Anyone person) $ 5, 000 PERSONAL 8 ADV INJURY $ 1, 0001 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 POLICY X PRO-LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ B ALL OWNED AUTOS SCHEDULED AUTOS DT8100161L68ATIL10 1/1/2010 1/1/2011 BODILY INJURY (Per accident) $ HIRED AUTOS NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000 XIOCCUR 1�1CLAIMS MADE AGGREGATE $ 10,000,000 $ C DEDUCTIBLE X RETENTION $ 0 AUC914113802 1/1/2010 1/1/2011 1 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 4038468 1/1/2010 1/1/2011 X WC STATU- OTH- TORY LIMIT $ ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1 $ 500,000 B OTHERScheduled Equipment QT6609469BO43TIL10 l/l/2010 1/1/2011 Limit $268,116 Deductible $1 , 000 BPP $206 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: Ground Lease @ Fort Collins/Loveland Airport City of Fort Collins is named Additional Insured in regards to General Liability per form CGD248 08/05. This certificate is subject to the terms, conditions, and exclusions of the policies. A 10-day notice of cancellation will apply in the event of non-payment of premium. CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO 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 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Eileen Munoz/CHRWAL ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD 77 ACORD 25 (2009/01) NS025 (200901 ) COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (CONTRACTORS OPERATIONS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by —the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and II. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products -completed op- erations hazard". 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to 'other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible 'other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such 'other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: I. How, when and where the 'occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and III. The nature and location of any injury or damage arising out of the 'occurrence" or offense. CG D2 48 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY b) If a claim is made or "suit' is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit' and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit' to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to 'other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 48 08 05 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. AUUMU Zo (2UUlluo) INS025 (oiw), o8a Page 2 of 2 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (CONTRACTORS OPERATIONS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to Include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work' to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop draw- Ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and it. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work' and included in the "products -completed op- erations hazard". 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to 'other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible 'other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such 'other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an 'occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: I. How, when and where the 'occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and ill. The nature and location of any injury or damage arising out of the "occurrence" or offense. CG D2 48 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY b) If a claim is made or "suit' is brought against the additional insured, the additional insured must: L Immediately record the specifics of the claim or "suit' and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit' to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to 'other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS; "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 48 08 05 A_ C0 D,m CERTIFICATE OF LIABILITY DATE(MMrDD/YYYY) -- INSURANCE I2/19/2008 PRODUCER (303)824-6600 FAX: (303)370-0118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Moody Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3773 Cherry Creek North Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 800 Denver CO 80209-3804 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Travelers Indemnity 25658 Alliance Construction Solutions INSURER B:Travelers Prop Cas Cc of 25674 Alliance Equipment Co., RLLLP INSURERc:Amer Guarantee Liab Ins 26247 2725 Rocky Mountain Avenue, Suite 100 INSURERD:Pinnacol Assurance 41190 Loveland CO 80538 INSURER E: 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 REDUQED BY PAID CLAIMS. INSR ADD'L TypEOFINSURANCE POLICY NUMBER POLICY EFFECTIVE P DAITEMM/DDNYON LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 300, 000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR DTCO01611,68AIND09 1/1/2009 1/1/2010 MED EXP (Any one erson $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JEOT LOC PRODUCT - COMP/OPA G $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) S B ALL OWNED AUTOS SCHEDULED AUTOS DT81001611,68ATIL09 l/l/2009 1/l/2010 BODILY INJURY (Per accident) $ HIRED AUTOS NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTOONLV EAACCIDENT $ OTHER THAN EA AGO $ ANY AUTO $ AUTO ONLY: AGO EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE EACH OCCURRENCE $ 10, 000, 000 AGGREGATE S 10,000,000 $ $ C DEDUCTIBLE AUC914113802 1/1/2009 1/1/2010 X RETENTION 0 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X WC STATU- OTH- LIM E.L. EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEES 500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under 4038468 1/l/2009 1/1/2010 E.L. DISEASE - POLICY LIMIT S 500,000 SPECIAL PROVISIONS below B OTHER Scheduled Equip QT6609469BO43TIL09 l/l/2009 1/1/2010 Limit 628,116 Deductible 1,000 BPP Limit 206, 000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Ground Lease @ Fort Collins/Loveland Airport City of Fort Collins is named Additional Insured in regards to General Liability per form CGD248 08/05. This certificate is subject to the terms, conditions, and exclusions of the policies. A 10-day notice of cancellation will apply in the event of non-payment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Fort Collins EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL PO BOX 580 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Fort Collins, CO 80522 -0580 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE L Ransom, CIC, CPCU/J ACORD 25 (2001/08) © ACORD CORPORATION 1988 INS025 (0I08).08a Page 1 of 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 (2001/08) INS025 pi w) oea Page 2 of 2 A CORDM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 12/22/2008 PRODUCER (303)824-6600 FAX: (303)370-0118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Moody Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3773 Cherry Creek North Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 800 Denver CO 80209-3804 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Travelers Indemnity 25658 Alliance Construction Solutions INSURER R Travelers Prop Cas Cc of 25674 2725 Rocky Mountain Avenue INSURERc:Amer Guarantee Liab Ins 26247 Suite 100 INSURER D:Pinnacol Assurance 41190 Loveland CO 80538 1INSURERE:Fireman's Fund Ins Cc 21873 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 H WN MAY HAVE BE EN RED CED BY PAID INSR LIEL ADOL INSR TYPE OF INSURANCE POLICY NUMBER POLICY POLICY MM/DDN) LIMITS GENERAL LIABILITY EA HOCCURRENCE S 11000,000 PREMAGSESEa oscuTO r�n $ 300,000 X COMMERCIAL GENERAL LIABILITY A CLAIMS MADE � OCCUR DTC00161L68AIND09 1/1/2009 1/1/2010 MED EXP An one person)$ 51000 PERSONAL B ACV INJURY $ 1, 0001000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODU TS-COMP OP AG $ 2,000,000 POLICY X PEO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 11000,000 BODILY INJURY B ALL OWNED AUTOS DT8100161L68ATIL09 1/1/2009 1/1/2010 SCHEDULED AUTOS (Per person) $ BODILY INJURY HIRED AUTOS NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN E6 ACO $ ANY AUTO $ AUTO ONLY: AGO EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE10, 000, 00C X OCCUR CLAIMS MADE AGGREGATE $ 101 000, OOO _ 5 C DEDUCTIBLE AUC914113802 1/1/2009 1/1/2010 $ X RETENTION S 0 D WORKERS COMPENSATION AND X I WC STATII OTH EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 4038468 1/1/2009 1/1/2010 E.L. DISEASE EA EMPLOYEE 5 500,000 If yes, describe under E.L. DISEASE POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below E OTHER Builders Risk MZ198473110 1/1/2009 1/1/2010 Limit 10,000,000 Deductible 25,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Contractor's License This certificate is subject to the terms, conditions, and exclusions of the policies. A 10-day notice of cancellation will apply in the event of non-payment of premium. 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 ACORD 25 (2001/08) INS025 dHoe).o8a AUTHORIZED REPRESENTATIVE Lynley Ransom, CIC, 1=1-1M��-rT-'"L�a--o.��-.-� © ACORD CORPORATION 1988 Page 1 of 2 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. AGUHD 25 (2001/UB) I NS025 (oioe).osa Page 2 of 2 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (CONTRACTORS OPERATIONS) This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" 'property damage" caused by 'your work" to include as an additional Insured on this Cover- and included in the 'products -completed op - age Part, but: erations hazard". a) Only with respect to liability for "bodily injury", 3. The insurance provided to the additional Insured "property damage" or "personal injury"; and by this endorsement is excess over any valid and b) If, and only to the extent that, the injury or collectible 'other insurance", whether primary, damage is caused by acts or omissions of excess, contingent or on any other basis, that is you or your subcontractor in the performance available to the additional insured for a loss we _ of 'your work" to which the "written contract cover under this endorsement. However, if the requiring insurance" applies, The person or written contract requiring insurance" specifically organization does not qualify as an additional requires that this insurance apply on a primary insured with respect to the independent acts basis or a primary and non-contributory basis, or omissions of such person or organization, this insurance is primary to 'other insurance" available to the additional insured which covers 2. The insurance provided to the additional insured that person or organization as a named insured by this endorsement is limited as follows: for such loss, and we will not share with that a) In the event that the Limits of Insurance of 'other insurance". But the insurance provided to this Coverage Part shown in the Declarations the additional insured by this endorsement still is exceed the limits of liability required by the excess over any valid and collectible 'other in - "written contract requiring insurance", the in- surance", whether primary, excess, contingent or surance provided to the additional insured on any other basis, that is available to the addi- shall be limited to the limits of liability re- tional insured when that person or organization is quired by that "written contract requiring in- an additional insured under such 'other insur- surance". This endorsement shall not in- ante". crease the limits of insurance described in 4. As a condition of coverage provided to the Section III — Limits Of Insurance. additional insured by this endorsement: b) The insurance provided to the additional in- _ a) The additional insured must give us written sured does not apply to "bodily injury", 'prop- notice as soon as practicable of an 'occur- erty damage" or 'personal injury" arising out rence" or an offense which may result In a of the rendering of, or failure to render, any claim. To the extent possible, such notice professional architectural, engineering or sur- should include: veying services, including: I. How, when and where the 'occurrence" 1. The preparing, approving, or failing to or offense took place; prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, persons and witnesses; and approving, or failing to prepare or ap- Ill. The nature and location of any injury or prove, drawings and specifications; and damage arising out of the "occurrence" or ii. Supervisory, inspection, architectural or offense, engineering activities. CG D2 48 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2