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Home My WebLink About389648 A-1 CHIPSEAL CO - INSURANCE CERTIFICATEJul 26 2011 15:43: S1 M6Lnt#: 53076 MSG# 39740IMcWftl Page 002 Of 805 ACORD,e CERTIFICATE OF LIABILITY INSURANCE DATE(MNUDDnYYY) 7/26/2011 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 en ADDITIONAL INSURED, the poney(les) must be endorsed, N 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 andorsement(s). PRODUCE0. CONTACT NAME: Willie of Colorado, Inc. A.q N, 1"'E,r_303 722-7776 FAX ac,Ne: 303-722.8862 720 South Colorado Boulevard E- B.----."----'---"'—"—" Suite 60ON ADDRESS_:__ _ INSURER(S) AFPOROINO COVERAGE NAIC0 Denver, CO 80246 INSURERA. Indemnity Company 25658 INSURED INSURERS TraVCIOrs Property Casualty Com 36161 A-1 Chipseal Company ............._....... _.._......... INsuREac: Pinnacol Assurance -.190 ......... 41790 DBA Rocky Mountain Pavement, LLC 2001 West 64th Lane INSURER D: Denver, CO 80221 INSURER E: INSURER P: COVERAGE$ CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT PIE 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 CONTRACTOR 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, BXCLUSIONS AND CONOITIONS OF SUCFI POLICIES. LIMITS ','"OWN MAY FIAVE BEEN REDU(,ED BY PAID CLAIMS. IN3R LTR '.ADOLSUBR TYPE tlFINEURANGE INOR WVQ POLICYNUMOOR„ POLI y Tt'F LMMIO f/Y%) PO�IpY �gP LMMIDO/YWY) A GENERALUABIL" DTC0019OP673 1010112010 10/01/2011 EACHOCCURPENCE $1000000 r_ X COMMERCIAL GENERAL LIADILITY ........ ..__.. C'TC RENTED RA��ilo "En=urrence .. s300000 _ � 'i,CLAWS-MADE" ` ~,OCCUR MEDF.XPIAAVunepsraonl b10000 X CGD2460605 X PERSONAL & ADV INJURY W s1 000 DOD J..._..._.,,,,,,...,,. __..______..... G61NERALACGRR ATE s2,000,000 i•EN'L AGGRE1G�AyTE� LIMIT APP�LIEjS PER: PRODUCTS - COMPIOP AGO b2 000 000 POLICY B'I AUTOMOBILE LIABILITY DT8100190P873 10/0112010 10101I2011 COMBINED SINGLE LIMIT Ea acctlgnt S1,OOQD00 BODILY INJURY IPer Pauon) S X ANV AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Para¢tlant) T X HIRED AUTOS X NON-O'NNED AUTOS PROPERTYDAMA,GE PPf dCC16Pn11 & f g X Y...� UMBRELIALIAB X OCCUR DTSMCUP019OP673 10101/2010 1010112011 EACH OCCURRENCE $10000000 AGGREGATE $10000000 EXCESS LIAO CLAIMS -MADE.: OEo 1 X RFIENTIr)N$10000 T C WORKERS tgMPENS4ngN AND EMPLOYERS'LIABILITY YIN! ANY PROPRIETORIPARTNEPiLitECUTIVE—'— OFFICERIMEM55R EXCLUDED? 1N_I N/A 4055760 1010112010 10/01/2011 X JWCSIArU. I IOTH- _.. TQPY.LIM[TS I IER..-. ,E;I„E4CN ACCIDENT_ ....... .... $SOO,(]D0 __,_ (MarMalary in NN) -"" E.L. DISEASE-EACMPLOYEE S500000 hyype. deacnte under DESCRIPTION OF OPERA rIONS bokry G.L. DISEASE-PCL ICY LIMIT 000000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Aeach ACORD 101, Additional Remarks ScIreONe, It more sea" Is required) Project Description: 2011 Asphalt Slurry Seal Project Number: 6054 The following are Additional Insureds as respects General Liability only if required by written contract and coverage applies only as (See Attached Descriptions) City of Fort Collins 300 Laporte Avenue Fort Collins, CO 80522 ACORD 25 (2010105) 1 of 2 #S844044IM759139 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE W/ TUM-ZUIU AGUKU GUKPUKA 1IUN. All ngHts reserved. The ACORD name and logo are registered marks of ACORD 8RSM1 respects ongoing operations performed by the Insured for the Additional Insureds, Additional Insureds: City of Fort Collins All coverage terms, conditions and exclusions of the policy apply. The Additional Insured endorsement which Is referenced above under'Type of Insurance -General Liability" Is attached. SAGITTA 25.3 HSO440441101759139 Jul 26 2011 15:44:57 MDT MSG# 39740953—BBB-1 Page BB4 Of 005 Insured: A-1 CNpseai Company Policy Number. DTC0019QP673 tOMMERGIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED . (CONTRACTORS) This cndorscmant modifies insurance provided underthe following: COMMER('JAL GENERAL LMILITY COWIRAGE PART 1. 2. WHO 18 AN INSURED — (Section 11) is arnendeq to Inciudo any person or rapanlzrdion that you agree in a "written contract requiring insurance" to include as an additional Inured on this Covert. age Part, bid: a) Only with respect to liability'for "bodily injury", , "property damage" or "personal injury"; and h) if, Rod only to the extent that, tho •Utjury or damage Is causod-by acts or ornissfons of you or your subcontractor in the performance of "your wbrV to which the "written contract rac uldrya Insurance" applies. 'rite parson or organization does not qualify as an additional insured vAth respect to the indepaddent acts or omissions of such person or Organization, The Insurance provided to the additional Insured by thts ondorsement is limited as foltows: a) In the event_ that the Limits of Insurance of this Coverage Pali flame in tho Cherlarabons exoued the limits of liability required'by the Witeu contract requiring Insurance°, the in- surance provided to the additional Insured shall be limited to the limits of gabllity�m- quired by that °written Contract requiring In- surance". This endorsement shall not to- cnlasa the limits of insurance described in section III — Limiter Of insurance, b) The insurance provided to the dddttional in- sured does not apply to "bodily Injury", "prop• erty damage" or "personal injury" adsing out of the rendering of, of failure to render, any profoRRlonal ArchitocluraL engineering orsur- veying services, Including: L The preparing, approving, or falling to prepare or approve, maps, shop drovt- Ings, opinions, reports, surveys, field or- ders or change order% or the preparing, approving, or failing to prepare or ap- prove, dmwtnga and apeclllcrdfons; and W. Supervisory, inspection, archltocwral or engineering Activities. c) The insurance provided to the additional In. sured does not apply to "bodgy'injory" or "pmperty damage" caused by "your work" and Included in the "products-complated op- oratlans W%ird" unless the "Watten conraat requiring bsuu SAW' apeeiticegy requires you to provide aunh oovorage for that additional insured, and then the insurance provided to the additional Insured applies only to such "bodily InJry,'"or "property darnage" that no• Buis heiore the end of the period of time for which the "wrhton coribac) requiring Insury ante" requires ynu to provido such coverage or the and of the policy period, whtchavcr is erldtor. 3. The insurance provided to the addillonal insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional Insured for a loan we Cover under Ibis endorsement. Hawovar,•If the When controot requiring insurance" specifically requua9 that this Insurance apply on a primary basis or a pdraRry and nornoordrarutory basis, this insurance is primary to "Driller Insurance" avaiiable to the additional insured which cabers that person or orgnnixnilon " a earned insured for such loss, and we will not share v4h that "ether tnsuraneo% But the Insurance provided to the additional Insured by this andrusement still Is excess over any valid and collectible ,other tn- surance", whether primary, exWsa, Contingent or on tiny other basis, that is available to the arkg- tionnl insured when that person or organizallon is an additional Insured under such %thpr Insur- once°. 4. As a condtlon 'of covorago provided to the additional Insured by this endorsement: a) The additional Insured must give us written notice as soon as practicable of an "occar• ronce" or an offense which May result in a claim. To the extent possible, such notice should Include: __O�.Dz�.OFYg6 � ,. ., �21YtY57Co'St;'Faiit'I"ravaldrs�oiljXirfl'cii,'�iriu. _ ......page'1•of2...... owner Jul Z6 2811 15:45:36 MDT MSG# 39748953-888-1 Page 8B5 BE BB5 Insured: A-1 Chipseal Company Policy Number: OTCM19OP573 COMMERCIAL. GENERAL t.l",Lrrk h) b. . c) d) ar, 1. How, Wien and whom the "occuminra" or offense took place; IL The mantes and addresses of any injured persons and vstnassas•, and Ili. •The nature and location of any Injury or darnage arising out Wituo "oaeurrence" or Offense. ff a claim Is made or "sulfl is brought against the additional ineurad, the additional insured must: I. immediately record Ilia spooiros of duo claim or "suit" and the date reeelved, Lin d U. Notify us as soon as practicable, 1'lio addittoual hlsuad most sue to it that we receive written notice of the ciatm or •suit, ac+ soon as practicable. The additional insured must Immediately send us copies of all legal pape)_s mootvad In connection with the claim or 'suit"; copporafe with us In the invesitgatlon or settlement of the Maim or defense against the "suit", and othorwisa comply with all pollay conditions. The additional Insured must tender tin da- rense and Indemnity of any datirt or `suit" to any provider of Gather insolence" which would cover the additional Insured for a loss wo rover Linder this endorsement. However, thio condition does not affect whathar the Incur, artoo provided to the additional Insured by this endorsement is pdn'wry to "other lasur ance" available to the additional Insured which cuvors that person or organization as a named insured as dowAhed in paragraph 1. above. 5. The follovAng dogriltion is added to SECTION V. DEFINMONS: 'Hon coniraot rawlit ig Insuraboe" means that partt of any written contract nr anreanlent undet• which you are required to Indisde a parson or organization as an additional in- sured on this Covaragn part, provided that the "bod4y hlluir and "pmpalty damage" oc- curs and the "personal hijury" is caLmod by an offense committed: n. Aflertho signing and exeruf ri of the contract ar agreement by you; b, VVhllo that part of the Oanlract or agreement Is In effect, and c. Before the end of the) policy period: .. "' PiWO-2 &2'-"' ' 02tio"Ina tit vdul Tfavolers compardes, inn. . . - td A2 d6 t19 06' .. .