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Home My WebLink About465532 CONCRETE STRUCTURES INC - INSURANCE CERTIFICATEACORDTM CERTIFICATE OF LIABILITY INSURANCE 1DATE 1/30/09DnrvY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Willis of Colorado, Inc. 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. Valley Forge Insurance Company 20508 Concrete Structures, Inc. INSURER B: American Casualty Company of Reading 20427 4325 Hilltop Road INSURER C: Pinnacol Assurance 41190 Longmont, CO 80504 INSURER D: Travelers Property Casualty Company 36161 INSURER E Transportation Insurance Company 20494 COVFROGFS 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 ADD'L INSRE PE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM DD/YY POLICY EXPIRATION DATE (MM/DDfYYI LIMITS A GENERAL LIABILITY 2047965998 11/30/09 11/30/10 EACH OCCURRENCE S1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $30O OOO CLAIMS MADE F_X] OCCUR MED EXP (Any one person) SS 000 PERSONAL & ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X PECo- X LOC E AUTOMOBILE LIABILITY ANY AUTO 2047965984 11/30/09 11/30/10 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 Hired Phys Dmg Limit $50,000 X X MX PROPERTY DAMAGE (Per accident) $ Comp Ded $1,000 Coll Ded $1,000 GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO S AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY 204966004 11/30/09 11/30/10 EACH OCCURRENCE $4000000 X OCCUR CLAIMS MADE AGGREGATE s4,000,000 $ DEDUCTIBLE $ X RETENTION $ 10000 C WORKERS COMPENSATION AND 4103172 04/01/09 04/01111 X WC' T A� CE EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 OO OOO E.L. DISEASE - EA EMPLOYEE $1 OO 000 OFFICERWEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT s500,000 D OTHER Owned QT6606045BO68TIL09 11/30/09 11/30/10 $155,000 Total Limit Leased/Rented $125,000 Blanket Limit Contractors Equip $1,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project Description: 7081 Bridge Replacement - Whitcomb and Magnolia This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract. (See Attached Descriptions) City of Fort Collins P. O. Box 580 Fort Collins, CO 80522 GANGELLA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'In* 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 ACORD 25 (2001/08) 1 of 3 #M655594 8VMAN 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 25S (2001/08) 2 of 3 #M655594 DESCRIPTIONS (Continued from Page 1) for fraud; i; other reasons AMS 25.3 (2001/08) 3 of 3 #M655594 ACORD-:, CERTIFICATE OF LIABILITY INSURANCE 1DATE 1130/09Dnrvvl PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Willis of Colorado, Inc. 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. Valley Forge Insurance Company 20508 Concrete Structures, Inc. INSURER B American Casualty Company of Reading 20427 4325 Hilltop Road INSURER C Pinnacol Assurance 1 41190 Longmont, CO 80504 INSURER D Transportation Insurance Company 1 20494 INSURER E. COVFRGGFS 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/DDIYYI LIMITS A GENERAL LIABILITY 2047965998 11/30/09 4,1;30/10 EACH OCCURRENCE ;1.000.000 X I COMMERCIAL GENERAL LIABILITY CLAIMS MADE 7 OCCUR pAMAGEGO RENTiED "rence s300.000 MED EXP (Any one person) s5,000 PERSONAL &ADV INJURY $1 000,000 All #G140331A 01101 GENERAL AGGREGATE s2 000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG s2 000,000 POLICY X PRCT X _OC D AUTOMOBILE LIABILITY ANY AUTO 2047965984 11f30/O9 11/30/10 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident l S HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO S AUTO ONLY. AGG B EXCESS/UMBRELLA LIABILITY 204966004 11/30/09 11/30/10 EACH OCCURRENCE s4,000.000 X OCCUR ❑ CLAIMS MADE AGGREGATE s4,000 000 s $ DEDUCTIBLE $ X RETENTION $10000 C WORKERS COMPENSATION AND 4103172 04/01/09 04/01/10 X Vl'C STATUS OTN- ER EMPLOYERS' LIABILITY ANY PROP RIETOR,IPARTNER/EXECUTIVE E.L. EACH ACCIDENT S100,000 E.L. DISEASE - EA EMPLOYEE $100,000 OFFICERWEMBER EXCLUDED? If yes. describe under SPECIAL PROVISIONS beloy: E.L. DISEASE -POLICY LIMIT I S500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Project Description: Whitcomb and Magnolia Bridge Replacement Project Number: 7081 The following are Additional Insureds as respects General Liability only (See Attached Descriptions) L,=M I Ir'I1.ii 1 C r1ULUCR City of Fort Collins 215 North Mason Street, 2nd Floor Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -10* 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 ACORD 25 (2001/08) 1 Of 3 #M655598 8VMAN CI 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 (2001108) 2 of 3 #M655598 DESCRIPTIONS (Continued from Page 1) if required by written contract and coverage applies 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 Workers' Compensation, Umbrella Liability, Auto Liability and General Liability policies include a Waiver of Subrogation in favor of the Additional Insureds 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 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 #M655598 G-140331-A (Ed, 01101) IMPORTANT: THiS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED 1N THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C.1.OF THiS ENDORSEMENT FOR THESE DUTIES. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED ENDORSEMENT WITH PRODUCTS - COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: SCHEDULE Designated Project* PER CERTIFICATE OF INSURANCE ATTACHED. (Coiie4jei-Under this-encioisei ieni is not aFfec ed `ny an enfry or Iaok of entry in the Schedule above.} A. WHO IS AN INSURED (Section iI) is amended to include as an insured any person or organization, including any person or organization shown in the schedule above, (called additional insured) whom you are required to add as an additional insured on this policy under a written contract or written agreement; but the written contract or written agreement must be: 1. Currently in effect or becoming effective during the term of this policy; and 2. Executed prior to the "bodily injury," "property 4vmage " nr " nronnol and adwertis[nn i it ... �.,y,., v� p,. -.vn.a w� u.ar�:. wu.u.� nijuij G-140331-A (Ed. 01101) B. The insurance provided to the additional insured is . limited as follows: 1. That person or organization is an additional insured solely for liability due to your negligence specifically resulting from "your work" for the additional insured which is the subject of the written contract or written agreement. No coverage applies to liability resulting from the sole negligence of the additional insured. G-140331-A (Ed. 01101) 2. The Limits of Insurance applicable to the e. An additional insured under this additional insured are those specified In the endorsement will as soon as practicable: written contract orwritten agreement or in the Declarations of this policy, whichever is less - } Give written notice of an occurrence or These Limits of Insurance are inclusive of, and These an offense to us which may result in a claim or "suit' under this insurance; not In addition to, the Limits of Insurance shown in the Declarations. (2) Tender the defense and indemnity of 3, The coverage provided to the additional insured any claim or"sult" to any other Insurer which also has insurance for a loss we by this endorsement and paragraph f. of the definition of "insured contract" under cover under this Coverage Part; and DEFINITIONS (Section V) do not apply to (3) Agree to make available any other "bodily injury" or "property damage" arising out insurance which the additional insured of the "products -completed operations hazard" has for a loss we cover under this unless required by the written contract or written Coverage Part. agreement. f. We have no duty to defend or indemnify an additional insured under this endorsement 4. The insurance provided to the additional insured until we receive written notice of a claim or "suit" from the additional insured. does not apply to "bodily injury,' "property damage;" or 'personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any 2. Paragraph 4.b of the Other Insurance Condition professional services including: is deleted and replaced with the following: a. The preparing, approving, or falling to 4. Other insurance . prepare or approve maps, shop drawings, b. Excess Insurance opinions, reports, surveys, field orders, change orders or drawings and This insurance is excess over any other specifications; and insurance naming the additional insured as an insured whether primary, excess, b. Supervisory, or inspection activities contingent or on any other basis unless i performed as part of any related a written contract or written agreement architectural or engineering activities. specifically requires that this insurance be either primary or primary.and noncontributing- C. As respects the coverage provided under this endorsement, SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS are amended as follows: 1. The following is added to the Duties In The Event of Occurrence, Offense, Claim or Suit Condition G-140331-A 2 (Ed. 01/01)