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HomeMy WebLinkAbout124948 TOP GUN PRESSURE WASHING INC - INSURANCE CERTIFICATE (9)TOPGU-1 OF ID: JO 'A`� CERTIFICATE OF LIABILITY INSURANCE DAM 07/14DIYYYY, onta/11 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 policy(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 endorsements . PRODUCER 303-867-2055 Olson & Olson Ltd. 303.867-2074 5655 S Yosemite Street #101 Greenwood Village, CO 80111 CONTACT PHONE FAX LacNo. E 1: ac No): EWAIL ADDRESS: INSURERS AFFORDING COVERAGE NA)C# INSURER A:Westfield Insurance Company 24112 INSURED Top Gun Pressure Washing, Inc. INSURER B: Pinnacol Assurance 500 W. 67th Avenue Loveland, CO 80538 INSURER C : INSURER 0: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 LTR TYPE OF INSURANCE ADOL SUB POLICY NUMBER POLICY EFF MMIDDIYYYY MVCOY % LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE LK OCCUR X X TRA6418137 06/21/11 06/21/12 EACH OCCURRENCE $ 1,000,00 A T RENTEO PREMISES Ea occurrence) S 100,00 MED EXP(Any one person) S 10,00 PERSONAL &ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LGO PRODUCTS - COMPIOP AGO $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS X TRA6418137 06/21111 06/21/12 COMBINEDI SINGLE LIMIT a�den S 1,000,00 X _Ea BODILY INJURY(Per person) $ BODILY INJURY (Per acatlent ) S X PROPERTY DAMAGE Per aoddent S 8 A j( UMBRELLAUAB EXCESS UAB X OCCUR CLAIMS -MADE TRA6418137 06121/11 06121/12 EACH OCCURRENCE $ 5,000,00 AGGREGATE S 5,000,00 OED X RETENTIONS 0 S B WORKERS COMPENSATION ANDEMPLOYERS'DABILRY ANY PROPRIETORNARTNERIEXECUTIVE YIN OFFICERMIEMBER EXCLUDED? � (Mandatory in NH) It yes, desmoe under DESCRIPTION OF OPERATIONS belmv NIA X 4031609 07/01/11 07/01112 WC STATU- OTH- X T RY LIMITS R E.L. EACH ACCIDENT S 1,000,00 E.L. DISEASE - EA EMPLOYEE S 1,000,00 E.L. DISEASE -POLICY LIMIT S 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Anach ACORD 104, Additional Remarks Schedule, it more apace la required) Contract Work. The City, its officers, agents and employees are included as Additional Insured as required by written contract as respects General Liability pper form CG3227 06/10 attached and Automobile Liability per form CA7068 03110 attached. General Liability & Workers' Compensation includes Waiver of Subrogation in favor of The City, its officers, CITYFO2 City of Fort Collins Purchasing Department John Stevens P.,O. Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD No Text COMMERCIAL GENERAL LIABILITY CG 32 27 06 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COLORADO ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional 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 be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused by your ongoing operations for the additional insured and only to the extent that such "bodily injury", "property damage" or "personal and advertising injury" is caused by your acts or omissions or the acts or omissions of those performing operations on your behalf. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" 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; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 32 27 06 10 0 Insurance Services Office, Inc., 2010 Page 1 of 1 13 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXPANDED PLUS COVERAGE ENDORSEMENT .This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM 1. BUSINESS AUTO COVERAGE FORM CA 0001 SECTION 11 - LIABILITY COVERAGE, sub - IS MODIFIED AS FOLLOWS: paragraphs (2) and (4) of Item A. 2. a. Cover- SECTION If • LIABILITY COVERAGE, Item A. age Extensions, Supplementary Payments are deleted and replaced with the following: 1. Coverage, Who Is An Insured is amended to include the following additional para- (2) Up to $5,000 for cost of bail bonds (in - graphs: cluding bonds for related traffic law vio- d. Any legally incorporated subsidiary of latlons) required because of an "accident" we cover. We do not have to yours in which you own more than 50% furnish these bonds. of the voting stock on the effective date of this coverage form. (4) All reasonable expenses incurred by the However, "insured" does not include any "insured' at our request, including actual subsidiary that is an 'insured" under any loss of earnings up to $500 per day be - other liability policy or would be an "in- cause of time off from work. sured" under such a policy but for its termination or the exhaustion of its limits SECTION II - LIABILITY COVERAGE, B. Ex- ofinsurance. cluslons, 5. Fellow Employee does not apply if the "bodily injury" results from the use of a e.. Any organization you newly acquire or covered "auto" you own or hire. form, other than a partnership or joint SECTION III - PHYSICAL DAMAGE COVER - .,venture, and over which you maintain AGE is amended as follows: ownership or a majority interest. How- ever, coverage under this provision: Item A. 4. Coverage, Coverage Extension is deleted and replaced by the.following: (1) Does not apply if the organization you acquire or form is an "insured" 4. Coverage Extensions under another liability policy or would be "Insured" under such a a. Transportation Expenses policy but for its termination or the We will pay up to $50 per day to a - exhaustion of its limits of insurance; maximum of $1,000 for transporta- (2) Does not apply to 'bodily injury' or tion expense incurred by you be - property damage' that occurred cause of the total theft of a covered "auto" before you acquired or formed the of the private passenger type. organization; and We will pay only for those covered "autos" for which you carry either (3) Is afforded only for the first 180 days Comprehensive or Specified Causes after you acquire or form the organ- of Loss Coverage. We will pay for Izatlon or until the end of the policy transportation expenses incurred period, whichever comes first. during the period beginning 48 hours afterthe theft and ending, regardless I. Any person or organization with whom of the policy's expiration, when the .you agreed in writing in a contract, covered 'auto" is returned to use or agreement or permit, to provide insur- we pay for its "loss." ance such as is afforded under this pol- icy. b. Personal Effects .This provision only applies if the We will pay up to $500 for the 'loss" written contract or agreement has of your personal effects that are been executed or permit has been contained in a covered "auto" due to issued, prior to the "bodily injury" or the total theft of the covered 'auto.' property damage'. We will pay only for those personal effects that are contained in covered g. Any "employees' of yours while using a 'autos" for which you carry either covered "auto" you do not own, hire or Comprehensive or Specified Causes borrow that "auto'. of Loss Coverage. ® insurance SW dcn OMM. mc., 2009 CA TO 513 03 10 Page 1 of 3