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HomeMy WebLinkAboutCENTRAL STATES ROOFING & INSULATING CO - INSURANCE CERTIFICATE'0 . rlianfli• 11;RR77 rFNTSTAT7 ' ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDfY 09/24/2010YYY) PRODUCER HUB International Ins Svcs Inc 1414 W 4th St P.O. Box 58 Pueblo, CO 81002 THIS CERTIFICATE IS ISSUED AS A MATTER OFINFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Central States Roofing & Insulating Co DBA Central States Roofing Company Inc 5925 Omaha Blvd Colorado Springs CO 80915 INSURER A: Valley Forge Insurance Company 20508 INSURER B: American Casualty Company of Re 20427 INSURER C: Pinnacol Assurance Company 41190 INSURER D: Continental Casualty Company 20443. 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. INSIR LTR 0%DD'L NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DDIYYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS A GENERAL LIABILITY 2088981026 09/27/2010 09/27/2011 EACH OCCURRENCE $1 OOO 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $500OOO CLAIMS MADE 51OCCUR MED EXP (Any one person) $5 000 PERSONAL & ADV INJURY S1,000,000 X $2,000 PD Ded/Occ X Contractual Llab GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X PECOT LOC Pollution $1 000 000 D AUTOMOBILE LIABILITY ANY AUTO 2088980944 09/27/2010 09/27/2011 COMBINED SINGLE LIMIT. (Ea accident) S1,000,000 X BODILY INJURY (Per person) S . 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 S F I ANY AUTO $ AUTO ONLY: AGG B EXCESS / UMBRELLA LIABILITY 2088980989 09/27/2010 09/27/2011 EACH OCCURRENCE $9 000 000 _X1 OCCUR CLAIMS MADE AGGREGATE $9 000 000 S DEDUCTIBLE $ X RETENTION $ 10,000 C WORKERS COMPENSATION AND 4090455 04/01/2010 04/01/2011 X WC STATU- OTH- I ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $100,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT s500,000 A OTHER Package - Co 2088981026 09/27/2010 09/27/2011 $100,000 Equipment $1,000 Deductible Leased/Rented DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Re: Roofing Project at EPIC and Senior Center, Bid No 6126 The City of Fort Collins and Aller, Lingle Architects P.C. and the Engineer's consultants are named Additional Insured in regard to Auto Liability and General Liability including completed operations and ongoing operations on a primary and non-contributory basis. Waiver of subrogation in favor of The City of (See Attached Descriptions) City of Fort Collins Purchasing Division 215 N Mason St 2nd Floor Fort Collins, CO 80522 orl 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 REPRESENTATIVES. ALLTHORIZEDEPRESEN/TA'TIVE _ �I ACORD 25 (2009/01) 1 of 3 #S858709/M854552 © 1988-2009 ACORD CORPORATION. All rights reserved. Tha ACrwn nama and Innn ara ranicfararl marlrc of ArnRn ST01 POLICY NUMBER;: 2088980944 CARi111AgOCIAL AUTO CA204029® THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATE® INSURED This endorsement modifies Insurance provided under the following. BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Cov®rags Form apply union rnodift by fhk endorsement. This endorsement identifies person(s) or organization(s) who we Insureds' under the Who is An Insured Provision of the Coverage Form. This endorsement does not after coverage provided In the Coverage Form. This endorsement changes the policy effective on She Inception date of the policy unless another data is Indicated below. Endorsement Eflective: 9-27-2010 1 CountarwMad a„ •,-. Named Insured: Central States Roofing e Company Inc SCHEDULZ Nam of perooer(o) or Blanket Applies. (If no entry appears above, Information required to oorrrplete this endorsement will be shown In the pedamftne as i appficebie to the endorsement) Each person or organization shown In the SdW* Is an Insured' for Liabill Cove or organization qualifies as an 'Insured' under the Who Is An Insured Provision oonitolnedtIn Secuon if to the of that person Form. the Coverage See Litt® O Z eas W" CA 20 40 02 69 Copyright, Insurance Services Office, Inc., 19M t of 1 DESCRIPTIONS (Continued from Page 1 ) Fort Collins and Aller, Lingle Architects P.C. and the Engineer's consultants. Excess Liability follows forms. See attached policy forms and conditions. G-140331-13, G-134802-C, G-56015, CA2048 AMS 25.3 (2009/01) 3 of 3 #S858709/M854552 nd 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 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) 2 of 3 #S858709/M854552 Central States Roof ing & Insulating Co DBA Central States Roofing`;Company Inc Policy #2088981026 Effective 9-27-10 NAM G-140331-8 (Ed. 01/09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ iT CAREFULLY. BLANKET ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIASIUTY COVERAGE PART SCHEDULE (OPTIONAL) Name (As required by written contractlagreement per Paragraph A. below.) LocaUon(s) of Covered Operations (As per the written contractlagreement, provided the location is within the "coverage terdlory" of this Coverage Part) (Coverage under this endorsement Is not affected by an entry or lack of entry in the Sehedutn arv,�o i A. Section II - Who is An Insured is amended to include as an additional insured any person(s) or organixation(s), including any person or organization shown in the Schedule above, whom you are required to add as an additional Insured on this Coverage Part under a written contract or written agreement, provided: a. The written contract or written agreement was executed prior to: 1. The "bodtfy Injwy" or 'property damage`; or 2. The olfanse that caused the "personal and adveftno Injury' for which the additional Insured seeks coverage under ttds Coverage Pad; and In the performance of your ongoing operations for the additional insured(s) or c. -your whoa that Is Included In the -products - completed operations hazard* and performed for the additional insured, but only if this Coverage Part provides such coverage, and only if the written contract or written agreement requires you to provide the additional Insured such coverage. 2. However, we wll not provide the additional Insured any broader coverage or any higher limit of insurance than the least of those: b. The written ooniract or written agreement pertains to your ongoing operations or "your work' for the additional insured(s). 3 S. The insurance provided to the additional Insured is limited as follows: 1. The person or orgardtatlon is an additional Insured only wills rasped to lablIlty for "bodily injury," "property damage; or "panxmal and advertising injury" caused In whole or in part by. a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf a. Required by On written contract or written agreement; b. Described in 8.1, above; or c. Afforded to you under this policy. This insurance is excess of Oil other Insurance available to the additional Insured, whether Primary, excess, cons rWM or on any other basis, uniess the written contract or agreement requires this insurance to be primary. In that event, Ihls Insurance will be primary relative to insurance which covers the addlllonal insured as a named. Insured. We will not require co ntribullon horn such Insurance It the wdtten c ontrea or written agreement also requires that this Insurance be non-contributory. But W th respect to all other insurance under which the additional Inured G-140331-8 Includes copyrighted materiel of insurance Services OIRce, Inc., with its permission Page i of 2 (Ed. 01/09) quallfles as an Insured or addflbcei Insured, this insurance will be excess. 4. The insurance provided to the additional Insured lennfnates When your operations for the additional insured are complete. But ff the written contract or written agreement specifies a dale until which this Insurance must apply, then this Insurance terminates: a, On the date specified in the written contract or written agreement; or b, When this policy expires or is cancelled, whichever occurs Prat. C. With respect tD the Insurance afforded to the additional Insured, the following additional exclusions apply. This insurance doss not apply to: 1. "Bodily injury," 'property damage," or "personal and advertising lnjury" 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; and b. Supervisory, Inspection, architectural or engineering activities. 2. "Bodily injury," "property damage," or "personal and advertising injury' arising out of any premises or worts for which the additional insured Is specifically listed as an additional insured on another endorsement attadred to this Coverage Part. D. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS Is emended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condrdon is amended to add the following additional conditions applicable to the additional insured: G-140331-8 (Ed. 01/09) An additional Insured under this endorsement will as soon as pnacticable: (1) Give us written notice of an "occurrence" or an offense which may r6sult In a claim or "suit under this Insurance, and of any claim or "suit" that does result (2) Tender the defense and Indemnity of any Cahn or "cult" to any other insurer or sell Insurer whose policy or program .applies to a ION we cover under this Coverage Part; (3) Except as provided In Paragraph 8.3 of tide endorsement, agree to make available any other Insurance the additional insured has for a loss we`cover under tfds Coverage part; and (4) Send us copies of all legal papers received, and otherwise cooperate with us in lire tmvesfigation, defense, or settlement of the claim or'suit.' We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional Insured written notice of a ciakn or'suV 2. With respect only to the insurance provided by this endorsement, the first sentence of Paragraph 4.a. of the Other Insurance Condition Is deleted and replaced with the following: 4. Oder insurance a. Primary insurance This insurance is primary and non- contributory except when rendered excess by this endorsement, or when Paragraph b. below applies. E. The provisions of the written contnad or written agreement do not In any way broaden or amend this Coverege Part. C-140331-8 Includes copyrighted material of insurance Services Of=, Inc., with its permission Page 2 of 2 (Ed. 01109) Central States Roofing & Insulating Co DBA Central States Roofing Company Inc 4.0 Policy #2088981026 Effective 9-27-10 CNA G-134802-C (Ed. I IM) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NONCONTRACTOR'S ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A. WHO 18 AN INSURED (8eet4oru IQ is amended to Include as an Insured any person or organization (called additional Insured) described In paragraphs 2a.through 29. below whom you are required to add as an additional Insured on this policy under a written contract or agreement but the written contract or agreement must be: 1. Currently in effect or becoming effective during the term of this policy; or 2. Executed prior to the 'bodily injury,' 'property damage' or'personal injury and advertising Injury,* but Oniy the following persons or organizatlons are addltionai insureds under this endorsement and coverage provided to such additional Insureds is limited as provided herein: a. Slate or Potltical Su>bdivIlsions A state or political mftivicon subjed to the following provisions: (1) This insurance applies only with respect to the following hazards for which the state or political subd'tvIdon has issued a permit in connection with promises you own, rent, or control and to which this Insurance apples: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, caller entrances, coal holes. driveways, manholes, marquees, holdaway openings, sidewalk vaults, West banners, or decorations and similar wgmurss; or (b) The motion, erection, or removal of elevators; or (a) The ownership, maintenance, or use of any elevators covered by this Insurance. (2) This Insurance applies only with rrespad to operations performed by you or on your ® behalf for which the state or political subdivision has Issued a permit. This Insurance does not apply to 'bodily injury; 'property damage' or 'personal and advertising Injury' arising out of t� operations performed for the slate or municipality. G-134802-C (Ed.11/04) b. cantromho brterest Any persons or organizations with a controlling Interest In you but only with respect to their liability arising out of: (1) Their ftnanclal control of you; or (2) Premises they own, maintain or control promises, lease or occupy these This Insurance does not apply to etruetuml alterations, new construction and demolition operations performed by or for such additional Insured C. 111110 mgera or Lessors of Premb" A manager or lessor of premises but only with respect to IlablHty arising out of the ownership, maintenance or use of that specific part of the premisee leased to you and subject to the following ac ditw sWualm: This insurance does not apply to: (1) Any 'occurrence' which takes place after you cease to be a tenant In that premises; or (2) Structural alterations, new construction or dernolidon on behalf o such uch additional rations Insured. rmed by or sured. d 111111misaw, AsaWm w Reoehror A mortgagee, assignee or receiver bull only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by you. This Insurance does not apply to atnWjjral alterations, new cmtstrum"on or demolition 01)"dOns performed by or for such additional insured. s. Owhara/Ot M hmtersate - Land Is Leased An owner or other interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and sub)ed to the following additional exclusions: This Insurance does not apply to: Page f of 2 (1) Any'occurrence' which takes place after you Deese to lease that land; or M Structural alterations, new construction or demolition operations performed by or on behalf of such additional Insured. f. Co-ownsr of Insured Promises A co-owner of a premises co -owned by you and covered under this Insurance but only 8. with respect to the oo-owners liability as co- owner of such premises. g. Lessor of Wment Any person or organization from whom you lease eq*Mnt. Such person or organization are insureds only with rasped to their liability for 'bodily injury,` 'property damage' or 'personal and advertising injury' caused, In whole or In part by your maintenance, operation of use of equipment leased to you by such person or organhation. A person's or organlzetion's statim as an Insured under this endorsement ends when their written contract or agreament with you for such lewd equipment ends. With respect to the insurance afforded these additional Insureds, the following additional exclusions apply: This Insurance does not apply: (1) To any 'occtnrenoe' which takes place after the equipment lease expires; or C-14i0W-C (Ed.11104) (2) To 'bodily injury' or 'property damage - arising out of the sole negligence of such additional insured. AnY Insurance provided to an additional Insured designated under paragraphs a. through g. above does not apply to 'bodily ia produc s-co6 Or m" damage- peted operations in thhazard.e As respects the coverage provided under this endorsement, Paragraph 4b. SECTION IV COMMERCIAL GENERAL LIA13un CONormNs Is deleted and replaoed with the following: 4. Dither breurence b. Excess Insurance This insurance Is excess over. Any other Insurance naming the additional insured as and Insured whether primary, excess, contingent or on any other basis unless 6 written contract or agreement specifically requires that this Insurance be either primary or primary and nonooMributing. Where required by written contract or agreement, we will consider any other insurance maintained by the additional Insured for Injury or damage covered by this endorsement to be excess and noncontributing with this Insurance. Gi--134802-C (Ed. 11104) Page 2 of 2 $.., POLICY Btlm INBURRD NAM AND ADDRSaD U 2088980944 CENTRAL SPATES ROOFIi40 Comm 5925 OKRKh. BLVD COLD ADO SPFIMS . CO 9091 S POLIO! t:'RAMMN 0923196 - OF "AROPM RLQB TS OF BBDMM Tale Change idareeeant dhaagsa the Policy. Please read it caref Ily. 2hia Change dndoreanent is a Part of Tons Policy mad t:s]oea &heat an the afteative date of your Policy, nnlese aaothow affeativa date is NUMM. 0923186 05/89 - WAIVER OF TRANSFER RION" OF RBCOV=Y US BEEN AHMED TO INCLUDE THE FOLLOWING: -ON WHOSE BEHALF YOU ARE R29UXRED TO OB2R1N 'THIS VAIVn OF OUR RIFT TO RECOVER FROM UNDER A WRITTEN CONTRACT OR AGRZgm=T' B= 1 c a-56015-8 i80. 11/91} loom.. . _... _ .. . _.__..---.,_..._ ... POLDI."r Rum= MUMUM KAUR AM "Miliff U 2088981026 CENTRAL STATES ROOPINa c0mmy 5925 0MMM BLVD POL i CXAKM VLXVJW OF vw8 OF aI,QBI e - CO 2406 This Change Badormemant ahaages the Policy. Please read it carefully. 22LU Change Endorsement is a part of roar Policy sad talons effect on the effective data o! your Policy, aaless another effeative date is shm a. CO 2408 - WAIVER OF TRANSM OF RIGHT'S Any person or organization that requires you to waive any right of recovery against then under a written contract or written a=eeetentp but the written contract or written agreement must be: 1. Currently in effect of becoming affective during the term of this policy; and 2. Executed prior to the "bodily injury,* 'property damage,• or •personal and advertising injury•. SM BEE Ary /'-'L� q d Me WSW ��."S- mot"` G-56015-B (ED. 11/91)