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HomeMy WebLinkAbout453145 INDEPENDENT ROOFING SEPCIALISTS LLC - INSURANCE CERTIFICATECORDmI� a CERTIFICATE OF LIABILITY INSURANCE 10/09/09D/YYYY) DATE E'A PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Willis of Colorado, Inc. I 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: Continental Western Insurance 10804 Iridependent Roofing Specialists, LLC INSURER B: Pinnacol Assurance 41190 4995 Locust Street INSURER Q Commerce City, CO 80022 INSURER D: INSURER E: RCIVFPAnFS 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 DD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS ' A GENERAL LIABILITY CNP2587871. 10/15/09 10/15/10 EACH OCCURRENCE $1 000 000 COMMERCIAL. GENERAL LIABILITY r DAMAGE TO RENTEDPREMISES (Ea occurrence) $250 000 CLAIMS MADE ® OCCUR _ MED EXP (Any one person) $5 000 PERSONAL & ADV INJURY $1. 00O 000 X PD Ded:5,000 CLCGO020 0307 GENERAL AGGREGATE s2,000,000 X GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X PRO- JECT X LOC A AUTOMOBILE LIABILITY ANY AUTO, CNP2587871 10/15/09 10/15/10 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS _ X BODILY INJURY (Per accident) $ .. HIRED AUTOS - NON -OWNED AUTOS - X PROPERTY DAMAGE (Per accident) $ .. GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO r $ . AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY CU2596758 - 10/15/09 10/15/16 EACH OCCURRENCE $1 00O O00 X OCCUR CLAIMS MADE - AGGREGATE $1 00O 000 $ DEDUCTIBLE - $ RETENTION $ B WORKERS COMPENSATION AND _ 4096550 1 O/O1 /O9 •t0/O1 /•� 0 X - WC STATU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $SOO,000 E.L. DISEASE - EA EMPLOYEE $500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500,000 A OTHER Equipment CNP2587871 10/15/09 10/15/10 $460,273 TIV $1,000 Ded. A Real & BPP CNP2587871 10/15/09 10/15/10 $490,000 TIV/$500 Ded. DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project Descriptions: EPIC Center, 1801 Riverside, Fort Collins, CO (See Attached Descriptions) GERIIFIGAI L HULULK GANGLLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3n* DAYS WRITTEN 215 North Mason NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TONDO SO SHALL 2nd Floor; P.O. BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Fort Collins, CO 80522 REPRESENTATIVES. AUTHORIZED REPRESENTATIIVEE... ACORD 25 (2001/08) 1 of 3 #M650995 8NPER © ACORD CORPORATION 1988 1 (2) Claims made or "suits" brought; or (3) Persons or organizations making claims or bringing "suits". d. The following are added to Section III — Limits Of Insurance: 8. Subject to 2. or 3. above, whichever applies, the most we will pay for the sum of: a. Damages under Coverage A; and b, Medical expenses under Cover- age C because of "bodily injury" or "prop- erty damage" arising out of the ac- tual, alleged or threatened dis- charge, dispersal, seepage, migra- tion, release or escape of "pollut- ants" is $100,000. CL CG 00 20 03 07 9. Subject to 8. above, the Medical Expense Limit is the most we will pay under Coverage C for all medi- cal expenses because of "bodily in- jury" sustained by any one person arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or es- cape of "pollutants". O. OTHER INSURANCE If this policy includes a Coverage.. Form or an Endorsement which providestycoverage for loss or damage covered by oneor more of the Ex- , tensions of this endorsement, the-fl'iinit ,and the coverage provided by this endorsement are de- leted and replaced ,by<Fthe limit -,.,and coverage provided by that _Coverage Forrn:orrEndorse- ment. yi;tyr' Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 8 of 8 I 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. nrnRn r9nnimm o „c -"neccnnnc DESCRIPTIONS (Continued from Page 1') Senior Center, 1200 Raintree Drive, Fort Collins, CO The following are Additional Insureds as respects General Liability only if required by written contract and coverage applies only as respects ongoing operations performed by the Insured for the Additional Insureds. Additional Insureds: City of Fort Collins All coverage terms, conditions and exclusions of the policy apply. 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 (2001/08) 3 of 3 #M650995 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. MEDICAL PAYMENTS r If SECTION I - COVERAGE C MEDICAL PAY- MENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit provided by this policy, subject to the terms of SECTION III - LIMITS OF INSURANCE, shall be the greater of: a. $10,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. B. FIRE, LIGHTNING, EXPLOSION, SMOKE AND SPRINKLER LEAKAGE DAMAGE TO PREM- ISES YOU RENT If damage to premises rented to you under Cov- erage A. is not otherwise excluded from this poi-, n� icy, the following applies:. 1. The last paragraph of SECTION I - GJ V- ERAGE A.2. Exclusions is deleted :and re=5` �. placed by the following: Exclusions c. through n. do A6ot~ apply to damage by fire, lightning, explosion or,--e kler leakage to premises:;: whilew;r..ented to`i:- your or temporarily occupied by"you W ,- permission of the owner`: ­'A separatelimitof insurance applies to!_;:this coverage a9prde- scribed in SECTION II[ --in't MITS OF IN- SURANCE. 2. Paragraph 6= ;of `SECTION °HI,:.;=4;111MITS OF INSURANCE is deleted and r!. `1placed by the .(b) That is Fire, Lightning, Explosion or Sprinkler Lea kage'i:psurap ee, for prem- ises rented to yo a "or>ternporarilyoccu- pied by you w,lth,,,the`permissiop,�o the owner; ;4a 4. Paragraph 91. of SECTION U­�- DEFINI- TIONS is deleted and replaceii. by the fol- lowing:__ a. A` contract for _a base of premises. However;that"poftion of the contract for of premises that indemnifies any ` persoh °or organization for damage by fire lightning, explosion or sprinkler =' leo premises while rented to you " or tem'poranly occupied by you with r"'' erm'ission of the owner is not an "in- ;r: P -.. shred contract"; C. N` .N-,.OWNED WATERCRAFT Q 6. Subject 'to5. above, the greater of: b. he Damage To Premises Rented E. zwzTo,You-Limit shown in the Declara- tions; is'`the 4most we will pay under COVER- AGE"A for damages because of "prop- erfy damage" to any one premises, while rented to you, or temporarily oc- cupied by you with the permission of the owner arising out of any one fire, light- ning, explosion or sprinkler leakage in- cident. 3. Paragraph 4.b.(1)(b) Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted and re- placed by the following: 1. -0aragraph g.(2) of SECTION I - COVER - :.,CAGE A.2. Exclusions is deleted and re- placed by the following: A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not used to carry persons or property for a charge. SUPPLEMENTARY PAYMENTS SECTION I - SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is amended as fol- lows: 1. The limit of insurance in paragraph 1.b. is increased from $250 to $2,500; and 2. The limit of insurance in paragraph 1.d. is increased from $250 to $500. AUTOMATIC ADDITIONAL INSURED - SPECIFIED RELATIONSHIPS The following is added to Paragraph 2. of SEC- TION 11 - WHO IS AN INSURED: e. Any person or organization described in paragraph f. below, whom you and such person or organization have agreed in writ- ing in a contract or agreement that such per- son or organization be added as an addi- tional insured on your policy. CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 1 of 8 Office, Inc., with its permission erations for a principal as a part of the same project. J CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 3 of 8 3. The insurance provided by this endorsement is primary insurance and we will not seek contribution under any insurance policy un- .der which such additional insured is a named insured, if such policy was procured and paid for by such additional insured, or a parent or'related entity of such additional in- sured. 4. With respect to the insurance afforded to these additional insureds, SECTION III — LIMITS OF INSURANCE is amended as fol- lows: The limits applicable to the additional in- sured are those specified in the written con- tract or agreement or the limits stated in the Declarations, whichever is less. If no limits are specified in the written contract or ,agreement, the limits applicable to the addi- tional insured are those specified in the Dec- larations. The limits of insurance are inclu- sive of and not in addition to the limits of in- surance shown in the Declarations. G. PROPERTY DAMAGE TO BORROWED EQUIPMENT , 1. Paragraph 2.j. of SECTION I - COVER- AGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is amended as follows: Paragraphs (3) and (4) of this exclusion do. not apply to tools or equipment loaned�f you, provided they are not being used ;to perform operations at the time of loss.. . 2. SECTION III — LIMITS OF INSURANCE is deleted and replaced by the folloNing:, The most we will pay in any` gne,..5„;:occur rence" for "property damage to 'G"orrowed. equipment is $15,000.;f This' limit `of.,,insur'! ance is the most we.:fwill pa:.y_.. regardless bf the number of: a. Insureds; b. Claims-made"or "suits °~brought; or C. Personas or organizations'making claims or bringing;`suits". 3. - Deductible a: Our obligationfo pay damages on be- ;- half bf..the :.iri'sured applies only to the ,,-amount`'of "damages in excess of $250 '`as applicable to "property damage" as tile: --,result of any one "occurrence", re- gartlless of the number of persons or organizations who sustain damages be- cause of that "occurrence". b. The terms of this insurance, including those with respect to our right and duty to defend the insured against, any "suits' seeking those damages; and your duties in the event of an "occurrence", claim, or "suit" apply irrespective of the applica- tion of the deductible amount. c. We .may pay any part or all of the de- ductible amount to effect settlement of any claim or suit and, upon notification of the action taken; you. shall promptly reimburse -us for such part of the de- ductible amount as we have paid. H. BROADENED NAMED INSURED-. Paragraph 3. of SECTION II - WHO IS AN IN- SURED is deleted and replaced by the follow- ing: Any organization, other than a join wbriture, over which you maintain ownership, -'or majority inter- est of more than 500/'o will be'a Named Insured if there is no other similar,,. insurance"'available to that organization. However: a. ' Coverage under this provisfon z is;`- afforded only until the;180th day after you acquire or form the organization or tile; -end of the pol- icy period; whichever is earlier: b. COVERAGE A does,.not-apply to "bodily in- jury" or-"prop'erty damage" that occurred be- quired or formed the organiza- tc:'4-COVERAGE B does not apply to "personal and advertising injury" arising out of an of- ?c fiense, committed before you acquired or "'`formed the or anization. [. +`CONSTRUCTION PROJECT GENERAL AG- GREGATE LIMIT ''$For all sums which the insured becomes legally, obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to the insured: a. A Single Construction Project General Aggregate Limit applies to each con- struction project away from premises owned by or rented to the insured, and that limit is equal-ta the amount of the General Aggregate Limit shown in the Declarations. b. The Single Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COV- ERAGE A, except damages because of "bodily injury or "property damage" in- cluded in the "products -completed op- erations hazard", and for medical ex- penses under COVERAGE C regard- less of the number of: (1) Insureds; (2) Claims made or. ".suits" brought; or (3) Persons or organizations making claims or bringing suits CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 4 of 8 Office, Inc., with its permission c. Any payments made under COVERAGE J. KNOWLEDGE OF OCCURRENCE A for damages or under COVERAGE C The following is added to paragraph 2. Duties In for medical expenses shall reduce the The Event Of Occurrence, Offense, Claim Or Single Construction Project General Ag- Suit of SECTION IV — COMMERCIAL GEN- gregate Limit for that construction pro- ERAL LIABILITY CONDITIONS: ject away from premises owned by or rented to the insured. Such payments e. A report of an "occurrence", offense, claim shall not reduce the General Aggregate or "suit" to: Limit shown in the Declarations nor shall (1) You, if you are an individual, they reduce any other Single Construc- tion Project General Aggregate Limit for (2) A partner, if you are a partnership, any other separate construction project away from premises owned by or rented (3) An executive officer; 'v1f< you . are a to the insured. corporation, or d. The limits shown in the Declarations for (4) A manager, if you`"are a 4iimited;_liability Each Occurrence, Fire Damage and company; Medical Expense continue to apply. is considered knowledge andW;requires you However, instead of being subject to the to notify us of the "occurrence", offense, General Aggregate, Limit shown in the claim, or "sui `i` b' s soon as ptacticable. Declarations, such limits will be subject to the applicable Single Construction - f. We are-,,, considered oRl` notice of an Project General Aggregate Limit. "occurreriee;offen_se.,elai`m or "suit" that is reported to-ayour�"Workers' Compensation 2. For all sums which the insured becomes ,insurer; .for 'h :;event which later develops legal obligated to a as damages caused 9 Y 9 pay g "o . -- , . " in oceurreice ,offense, claim or "suit" by "occurrences" under COVERAGE A =i ^: for which there is coverage under this policy. (SECTION q, and for all medical expenses ,r .. However, we will only be considered on caused by accidents under COVERAGE C F_ f *notice if you`notify us as soon as you know (SECTION I) which cannot be attributed riFtte claim"should be addressed by this policy only to ongoing operations at a single des- -_'` rather ``than your Workers'. Compensation ignated construction project away from,_.� , µ. poi dy. premises owned by or rented to the insured -AP �� K. UNINTENTIONAL OMISSIONS a. Any payments made under COVERAGE A for damages or under COVERAGEt:.Aw+_>n�=- The following is added to paragraph 6. Repre- for medical expenses shall red;,uce the"; i sentations of SECTION IV - COMMERCIAL �'nera amount available under -the G.l Ag- "-tom;, GENERAL LIABILITY CONDITIONS: ;_. gregate Limit or then' Products-`' Completed Operations Aggregate-i;Limit,,;�,; d, If you unintentionally fail to disclose any exposures existingat the inception date of whichever is applicable.;�.and`' ._ ` „ your policy, we will not deny coverage under ..:.;. b. Such payments shall riot reduce, any this Coverage Part sole) because of such 9 Y F- Single Construction Project GeneralAg- failure to disclose. However, this. provision gregate Limit- does not affect our right to collect additional �,,.. premium or exercise our right of cancellation 3. When coverage>afor liability;,arising out of the or non -renewal. "products -completed operafions hazard" is any payments for,;=tlamages be- This provision does not apply to any known ,.provided,,_; cause of ,bodil in a or " ro ert damage" Y i ry",. P P Y g injury or damage which- is excluded under an other provision of this policy. y p P y' included it $he products -completed opera- tion.s. hazard" `will reduce the Products- L. MENTAL ANGUISH C.ompfeted Operations'Aggregate Limit, and ;trot reduce the Gei'eral Aggregate Limit nor Paragraph 3. of -SECTION V — DEFINITIONS is =' fthe Singler.Construction Project General Ag- deleted and replaced by the following: gregate Limit:-"' 3. "Bodily injury" means bodily injury, sickness 4. if tteapplicable construction project away or disease sustained by a person, including mental anguish or death resulting from any from premises owned by'or rented to the in- of these at any time. sured,:has been abandoned, delayed, or abandoned and then restarted, or if the au- M. WAIVER OF TRANSFER OF RIGHTS OF RE- thorized contracting parties deviate from COVERY AGAINST OTHERS plans, blueprints, designs, specifications or timetables, the project will still be deemed to Paragraph 8. Transfer Of Rights Of Recovery be the same construction project. Against Others To Us of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDITIONS 6. The provisions of, Limits Of Insurance is amended by the addition of the following: (SECTION 111) not otherwise modified by this endorsement shall continue to apply as stipulated. CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 6 of 8 Office, Inc., with its permission We waive any right of recovery we may have because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract requiring such waiver with that person or organization and included in the products -completed operations hazard". However, our rights may only be waived prior to the "occurrence" giving rise to the injury or dam- age for which we make payment under this Cov- ei Ic sl u N. L Nc� aoi, accray., n "y...., release or escape of "pol- lutants" arises at or from any premises, site or loca- tion which any insured or any contractors or subcon- tractors working directly or indirectly on any insured's behalf are performing op- erations if the "pollutants" are brought on or to CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 6 of 8 Office, Inc., with its permission the premises, site or loca- tion in connection with such operations by such insured, contractor or subcontractor. Subparagraph (b) does not apply to "bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire". 191 Anv loss_ cost or expense aris- c. Paragraph 1. of Section III — Limits Of Insurance is replaced by the following: The Limits Of Insurance shown in this endorsement, or in the Declarations and the rules below fix the most we will pay regardless of the number of: (1) Insureds; CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 7of8