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Home My WebLink About476185 AMERICAN CIVIL CONSTRUCTORS INC - INSURANCE CERTIFICATEAt,✓ h® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 07/`07, 011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies)must be endorsed. 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). PRODUCER CONTACT NAME' PHONE FAX N IN877-945-7378 cN 888-467-2378 Willie of Colorado, Inc. 26 Century Blvd. P. O. Box 305191 Nashville, TN 37230-5191 E-MAIL ADDRE certificatesLawillis.com INSURER(S)AWORDING COVERAGE NAICN INSURER A: Arch Insurance Company 11150-001 INSURED American Civil constructors, Inc. INSURER B: National Union P1re Insurance Company Of 19445-001 INSURERC: Division 201 4901 Swindermere St Littleton, CO 80120 INSURER D: INSURER E: INSURER F' COVERAGES CERTIFICATE NUMBER: 16262172 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rypE OFINSURANCE DD' SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS -LIEL A GENERALLIABILITY y 71PKG2326606 7/l/2010 10/1/2011 EACHOCCURRENCE S 2,000,000 PREMSESOEa6accur0ence $ 300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL& ADV INJURY $ 2,000,000 GENE RAL AGG R EGATE S 4,000,000 G ENT AGGREGATE LI MIT APPLIES PER PRODUCTS-COMP/OP AGO $ 4,000,000 $ POLICY X JECT -1 PRO LOG A AUTOMOBILELIABILITY 71PKG2326606 7/1/2010 10/1/2011 COMBINED SINGLE LIMIT(Eaaccd $ 1, 000,000 BODILY INJURV(Per person) $ X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURV(Per accident) $ PR MA Per acadent $ X HIREDAUTOS I X NON -OWNED AUTOS $ $5 ed. Code $5 000 Col X I1ed. X 1 Died. B X UMBRELLALIAB X OCCUR y BE23465062 7/1/2010 10/l/2011 EACHOCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION$ 10,000 Is A WORKERS COMPENSATION 71WCI2326507 7/1/2011 10/1/2011 X U ITS ER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? fiMandidoryIn NH) yea, describe under DESCRIPTION OFOPERATIONS below N/A El, EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach Acord 1 D1, Addltonal Remarks Schedule, it more space Is required) Project: 7244 Linden Street Streetscape This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract. The followinor are Additional Insureds as respects General Liability and Umbrella only if required SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE ACCORDANCE WITH THE AUTHORIZED REPRESENTATIVE City of Fort Collins P.O. Box 580 Ft. Collins, CO 80522 NOTICE WILL BE DELIVERED IN C011:3412149 Tpl:1299180 Cert:16262172 @1988-20120AC RD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: HRH65735 LOC#: A� ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED American Civil Constructors, Inc. Willis of Colorado, Inc. Division 201 POLICY NUMBER 4901 Swindermere St Littleton, CO 80120 See First Page CARRIER NAIC CODE cee a; --- ---- EFFECTIVE DATE: cee v; _nf Da..0 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORAANInARFn• 25 FnwnA TIT[F- CERTIFICATE OF LIABILITY INSURANCE contract and coverage Insureds. All coverage respects work performed by the Insured for the no and exclusions of the policy apply. Additional Insureds: City of Ft. Collins and State of Colorado The General Liability coverage is Primary and Non -Contributory per the policy terms & conditions only if required by written contract. 101 (2008/011 Co11:3412149 Tn1:1299180 Cert:16262172 (d200RACORDDORPORATION_All rin hts resarvad The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — AUTOMATIC STATUS WHEN REQUIRED BY A CONSTRUCTION AGREEMENT WITH YOU — COMPLETED OPERATIONS — PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: Section II — Who is an Insured is amended to include as an insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is an additional insured on your policy. Such person or organization is an additional insured only with respect to liability arising out of: i) "your work" at the location designated; or ii) the `products -completed operations hazard." Coverage afforded to these additional insured parties will be primary to, and non- contributory with, any other insurance available to that person or organization. All other terms and conditions of this Policy remain unchanged. Policy Number: 71 PKG2326606 Named Insured: American Civil Constructors, Inc. This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 7/1/2010 00 ML0019 00 08 06 Page 1 of 1 POLICY NUMBER: 71 PKG2326606 COMMERCIAL AUTO CA20701001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE FOR CERTAIN OPERATIONS IN CONNECTION WITH RAILROADS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIERS COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided under this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: American Civil Constructors, Inc. M M I op INES) SCHEDULE (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement. ) With respect to the use of a covered "auto" in operations for or affecting a railroad designated in the Schedule at a Designated Job Site, the two exceptions contained in the definition of "insured contract' relating to construction or demolition operations performed within 50 feet of a railroad do not apply. CA 20 70 10 01 Pages 1-1 0 ISO Properties, Inc.,2000 POLICY NUMBER: 71 PKG2326606 COMMERCIAL GENERAL LIABILITY CG 24 1710 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTUAL LIABILITY - RAILROADS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Scheduled Railroad: Designated Job Site: City of Ft. Collins and State of Colorado Project: 7244 Linden Street Streetscape (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect to operations performed for, or affecting, a Scheduled Railroad at a Designated Job Site, the definition of "insured contract' in the Definitions section is replaced by the following: 9. "Insured Contract' means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract'; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: CG 24 17 10 01 ® ISO Properties, Inc., 2000 (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to.give them, if that is the primary cause of the injury or damage; (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in Paragraph (1) above and supervisory, inspection, architectural or engineering activities. CG 24 17 10 01 C ISO Properties, Inc., 2000