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HomeMy WebLinkAboutTHE GREEN PLAN INC - INSURANCE CERTIFICATE (2)AC" ® DATE (MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 10/30/2009 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: Peerless Indemnity Ins Co 18333 The Green Plan, Inc. INSURER B: Pinnacol Assurance 41190 645 Compton Street INSURER C: St Paul Fire & Marine Ins Co 24767 INSURER D: Broomfield CO 80020-1634 INSURER E: r_nVFRAr,FS 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 LT ADDII POLICY NUMBER POLICY EFFECTIVE DATE MM DD YYY POLICY EXPIRATION DATE(MMIDDNYYYIF LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 1XI OCCUR CBP8536180 ll/l/2009 11/1/2010 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 lanket Add' 1 Insured per form 22-132 01-08 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: attached 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) $ A ALL OWNED AUTOS SCHEDULED AUTOS BA8532256 ll/l/2009 11/1/2010 BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT j $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 51000,000 X OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 $ A DEDUCTIBLE CU8534556 11/l/2009 11/1/2010 $ X RETENTION $ - 10,000, - B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OF EXCLUDED? E.L. DISEASE -EA EMPLOYEE$ 500,000 (Mandatory in NH) 4044669 11/1/2009 11/1/2010 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT I $ 500,000 C OTHERExCeSS Liability 106400865 ll/1/2009 11/l/2010 Occurrence 5, 000, 000 Aggregate 51000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Re: Old Town Square Irrigation System Project #6084 The City of Fort Collins and Downtown Development Authority are named as Additional Insureds with regards to General Liability. 10 Day Notice of Cancellation Applies to Non -Payment of Premium. This certificate is subject to the terms, conditions, and exclusions of the policies. (303)938-8137 City of Fort Collins Purchasing Division 215 North Mason Street 2nd Floor Fort Collins, CO 80524-4402 LrAIVIotLLA 1 IUN SHOULD ANY OFTHE 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 Navarra, ACSR, CRIS ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered 'marks of ACORD 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 This Certificate of Insurance 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 (2009/01) INS025 (200901) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph 2. under Section 11— Who Is An Insured is amended to include as an additional insured any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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; in the performance of your ongoing operations for the additional insured that are the subject of the written contract or agreement provided that the "bodily injury" or "property damage" occurs, orthe "personal and advertising injury" is committed, subsequent to the execution of such contract. A person's or organizations status as an additional insured under this endorsement ends when your operations for that additional insured are completed. We have no duty to defend an additional insured under this endorsement until we receive written notice of a claim or "suit' as, required in provision b.,of Condition 2: Duties In the Event Of:Occurrence, Offense, Claire Or Suit under SECTION IV = COMMERCIAL GENERAL LIABILITY CONDITIONS. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1 "Bodily injury" or "property damage" arising from the sole negligence of the additional insured. 2. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the location where such "bodily injury" or"property damage"'occurs. 3. , ,'Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of; or -the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 4. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 5. Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED —OWNERS, LESSEES OR CONTRACTORS endorsement issued by us and made a part of this policy, Includes copyrighted material of Insurance Services Office, Inc., with its permission. 22-132 (01/08) Page 1 of 2 INSURED COPY 11/01/2008 8536180 NCCOMM111 PGDMO60D J16656 LCAOPPN odDn2837 Pacle 99A C. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations, of this policy and defined in SECTION III — LIMITS OF INSURANCE of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. D. With respect to the coverage afforded by this endorsement, SECTION IV —COMMERCIAL GENERAL LIABILITY is amended as follows: 1. The following is added to Condition 2. Duties In The Event Of Occurrence, Claim Or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an `occurrence" or an offense, that may result in a claim or "suit' under this insurance to us; b. Tender defense and indemnity of any claim or "suit' to all insurers .whom also have insurance available to the additional insured; and c. Agree to advise us of any other insurance which the additional insured has for a loss we cover under this Coverage Part. However, this condition does not affect whether the insurance provided to the additional insured by this endorsement is primary as described in Condition 4.a. as amended by this endorsement. 2. Condition 4;.Other Insurance is amended as follows: . . a. The following is added to paragraph a. Primary Insurance: With respect to other insurance for which the additional insured is designated as a Named Insured, this insurance will be primary if you and the additional insured have agreed in writing,. in a contract or - agreement, that this insurance is primary or primary and non-contributory. Our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the _ method described in provision 4.c. Method of Sharing b. The following is added to paragraph b. Excess Insurance: When the written agreement between you and the additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the additional insured is -designated as a Named Insured. Regardless of the written agreement between you and the additional insured, this insurance is excess .over any -other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured by attachment of an endorsement or otherwise. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 22.132 (01108) Page 2 of 2 4 4 M4 ionnn RFZR4An ni�llnnat eni 4 1 INSURED COPY ����^��