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Home My WebLink About111183 COULSON EXCAVATING CO INC - INSURANCE CERTIFICATE (2)_I` Client#:52589 8COULEXC ACORD.1 CERTIFICATE OFLIABILITY INSURANCE DATE ' 02/09/09° 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 60ON :Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Zurich American Insurance Company 16535 Coulson Excavating Co., Inc. 3609 North County Road #13 Loveland, CO 80538 INSURER B: RSUI Indemnity Company 22314 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 POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DDIYY LIMITS A GENERAL LIABILITY GLO3888949 05/01/08 05/01/09 EACH OCCURRENCE $1 000 000 GENERAL LIABILITY DAMATO RENTED$1OO REMGEMERCIAL OOO MED EXP (Any one person) $10 000 CLAIMS MADE 51OCCUR N(312,007) PERSONAL & ADV INJURY $1 00O 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X PROECT LOC J A AUTOMOBILE. LIABILITY X ANY AUTO BAP3888950 05/01/08 05/01/09 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS 5 X HIRED AUTOS X NON -OWNED AUTOS , BODILY INJURY (Per accident) $ y X Ltd Pollution PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY w AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ i ANY AUTO $ AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE NHA221387 05/01/08 05/01/09 EACH OCCURRENCE s5,000,000 AGGREGATE s5,000,000 $ $ DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND WC3888959 05/01/08 05/01/09 0 STAT. U- CIETH- X I Tw.R EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE E.L- EACH ACCIDENT 1$1,000,000 E-L. DISEASE - EA EMPLOYEE $1 OOO OOO OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $11000 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS Project Description: West Harmony Road Improvements Bid No.: 7004 The following are Additional Insureds as respects General Liability only (See Attached.Descriptions) I.CR I Irm m I C rIVLUCR GANGtLLA I TUN City of Fort Collins .215 North Mason Street 2nd Floor Fort Collins, CO 80525 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL An* 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 AUTHORIZED REPRESENTATIVE 17 - .A ef. AwrcU.zo IwU-uval 1 of 3 •#S622649/M583972 BMSTY 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. s a i i f E A(;UKU 25-b (Z UMB) .2 of.3 #S622649/M583972 if required by written contract and coverageapplies only -as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions and.exclusions.of the policy apply. Additional Insureds: City of Fort Collins The General Liability coverage is Primary per the policy terms & conditions 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 representscoverage 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 4m5 Zb.3 (ZUU7/US) 3 of 3 #5622649/M583972 Additional Insured — Automatic — Owners, Lessees Or Contractors ZURICH Policy No. Exp. Date of Pol. Eff. Date of End. Agency No. Addl. Prem. Return Prem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Address (including ZIP Code): This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II — Who Is An Insured is amended to include as an insured any person or organization who you are re- quired to add as an additional insured on this policy under a written contract or written agreement. B. The insurance provided to the additional insured person or organization applies only to "bodily injury", "property damage" or "personal and advertising injury" covered under SECTION I - Coverage A - Bodily Injury And Prop- erty Damage Liability and Section I - Coverage B - Personal And Advertising Injury Liability, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, and resulting directly from: a. Your ongoing operations performed for the additional .insured, which is the subject of the written contract or written agreement; or b. "Your work" completed as included in the "products -completed operations hazard", performed for the addi- tional 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 organiza- tion 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. Includes copyrighted material of Insurance Services Office, Inc., with its permission, U GL 1175-B CW (3/2007) Page 1 of 2 D. The insurance provided to the additional insured person or organization does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" ari.,ing out of the rendering or failure to ren- der any professional architectural, engineering or surveying services including: 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. E. The additional insured must see to it that: 1. We are notified as soon as practicable of an 'occurrence" or offense that may result in a claim; 2. We receive written notice of a claim or "suit" as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the written contract or written agree- ment requires that this coverage be primary and non-contributory. F. For the coverage provided by this endorsement: 1. The following paragraph is added to Paragraph 4.a. of the Other Insurance Condition of Section IV — Com- mercial General Liability Conditions: This insurance is primary insurance as respects our coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Com- mercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same 'occurrence", claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. G. This endorsement does not apply to an additional insured which has beer added to this policy by an endorsement .showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured, Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to apply as written. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1 175 B CW (3/2007) Page 2 of 2