Loading...
HomeMy WebLinkAbout102829 DON KEHN CONSTRUCTION - INSURANCE CERTIFICATEACORDTM CERTIFICATE OF LIABILITY INSURANCE (MM/D 0DATE 9/30/10DfYYYY) 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: Zurich American Insurance 16535 Don Kehn Construction, Inc. INSURER B: Everest National Insurance Co. 10120 6550 SCR5 INSURERC: Pinnacol Assurance 41190 Fort Collins, CO 80528 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. INSR LTR D INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM DD POLICY EXPIRATION DATE MM/DD LIMITS A GENERAL LIABILITY GLA5942579 11/01/09 11/01/10 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES IEa occurrence) $300OOO CLAIMS MADE � OCCUR MED EXP (Any one person) $5 000 PERSONAL & ADV INJURY $1 00O 000 X Ltd Pollution X AI# UGL1175BCW 3/07 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY 7X PRO LOG JECT A AUTOMOBILE LIABILITY ANY AUTO GLA5942579 11/01/09 11/01/10 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 DAMAGE (Per accident) $ Ltd PollkutionPROPERTY N GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY 71CH000023091 11/01/09 11/01/10 EACH OCCURRENCE s2,000,000 X OCCUR CLAIMS MADE AGGREGATE s2,000,000 $ $ DEDUCTIBLE $ X RETENTION $ 10 000 C WORKERS. COMPENSATION AND_ 209395,0, :: :-.•. ., - .. �1.0/011-0 ,.10/01/1.1. - _�.:- ,X t WCSTATU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500OOO E.L. DISEASE - EA EMPLOYEE $500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Project Description: Mining Reclamation Agreement regarding Arapahoe Bend Natural Area. The following are Additional Insureds as respects General Liability only (See Attached Descriptions) L,CK I IrII.A I C rIULUCK (rAN(:CLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Ft. Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1n* DAYS WRITTEN PO Box 580 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Fort Collins, CO 80522-0580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE dr _ . .A . AGUKU LO (LUUI/UU) 1 Of 3 #S720227/M720067 8MSTY © ACORD CORPORATION 1988 To \ o-o lq 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 (2001/08) 2 of 3 #S720227/M720067 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 #S720227/M720067 0 Additional Insured — Automatic — Ow-ners, Lessees Or ZURICH Contractors Policy No. Exp. Date of Pol. I Eff. Date of End. I Agency No. I Addl. Prem. I Retum 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 pa rt� by: . 1. Your acts or .omissions; or 2. The acts or omissions of those. arting.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. 1-he Lim its 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-1 175-B CW (3/2007) Pa-,e 1 of2 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. F. The additional insured must see to it that: 1. We are notified as soon as practicable of an "occurrence" cr.uffeZse that mav-'result ink claims 2. We,receive written notice of a claim or "suit." as soon: As.pracf cable; and 3. A request for defense and indemnity of the claim or "suit" will promptiy 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 Nained 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 f' e Other insurance Condition of SectionIV— Com- mercial General Liability Conditions: 'This insurance'{is �priinary insurance as r �pects.our,.:ovvrage 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,.yie'will not seek contribution from any other insurance policy available to the additional insured or, 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 —_ Corn- 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''coi cred as an additional' insured;by. attachment of `an-cfidOrSement to another policy providing ove"age fv^r til Sam iCGUr :il "�:Gldin ornSU1t" This piUViSIGiI 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 contractor written agreement to provide coverage to the additional insured on a prii-nary and non-contribtitory 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 Schedu.l•e.of additional insureds, acid which endorsement applies specifically to that identified additional nsured. .. .j Any provi`sioi�s ill tills Covera" c P'al-, not rhan�ed'b' th'e'terms and c�naliions "of this endorsement continue to apply as written. Includes copyrighted material of insurance Services Off cc, Inc., with its permission. U-GL-1 175 B Cw (3/2007) Page 2 of 2