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Home My WebLink About389648 A-1 CHIPSEAL COMPANY - INSURANCE CERTIFICATE (7)Client#: 53076 8AICHIPS ACORD- CERTIFICATE OF LIABILITY INSURANCE D 7/2612/DD/YYYr 126/2011 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 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 endorsement(s). PRODUCER CONTACT NAME: Willis of Colorado, Inc. PHONE 303 722-7776 F'4% 303-722-8862 A/c, No Ezt : A/C No 720 South Colorado Boulevard E-MAIL ADDRESS: Suite 60ON INSURER(S) AFFORDING COVERAGE NAIC # Denver, CO 80246 INSURER A: Travelers Indemnity Company 25658 INSURED INSURER B: Travelers Property Casualty Com 36161 A-1 Chipseal Company INSURER C Pinnacol Assurance 41190 DBA Rocky Mountain Pavement, LLC 2001 West 64th Lane INSURER D: Denver, CO 80221 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 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L RR TYPE OF INSURANCE NSRLSUEN MD POLICYNUMBER MMI�D/YYEYW MM/DDT LIMITS A GENERAL LIABILITY DTC00190P673 10/01/2010 10/01/2011 EACH OCCURRENCE $11111000,000 PREMISES REoccu ante 8 MAN X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR MED EXP (Anyone Person) $10 000 PERSONAL SADVINJURY $1,000,000 X CGD2460805 X GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG E2,000,000 POLICY X PRO LOG JECT $ B _ AUTOMOBILE LIABILITY DT810019OP673 10/01/2010 10/01/2011 COMBINED SINGLE LIMIT (Ea accidem $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) b X DAMAGE Per accident $ HIRED AUTOS X NONOWNEDPROPERTY AUTOS E B X UMBRELLA LIAB X OCCUR DTSMCUP019OP673 0/01/2010 10/01/2011 EACH OCCURRENCE $10 000 000 AGGREGATE $1 O 00O 000 EXCESS LIAR CLAIMS -MADE DED I X RETENTION $10000 $ _ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � N/A 4055760 10/01/2010 10/01/2011 X WCSTATU- OTH- ULn E.L. EACH ACCIDENT s5O0 OOO E.L. DISEASE - EA EMPLOYEE $500000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS We. E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) 1 of 2 #S844044/M759139 W TUCC-ZUTU AUUKU CUKPUKA I IUN. All rights reserved. The ACORD name and logo are registered marks of ACORD 8RSM1 T 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 (2010105) 2 of 2 #S844044/M759139 Insured: A-1 Chipseal Company Policy Number. DTCO0190P673 60MIMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED . (CONTRACTORS) This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section In is amended to include any person or organization that you agree In a written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodgy injury', "property damage" or "personal injury"; and fi) ff, and only to the extent that, the injury or damage is caused -by ads or omissions of you or your subcontractor In the performance of your work" to which the "Written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional Insured by this endorsement Is limited as foitows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required'by the "written contract requiring insuranoe", the in- surance provided to the additional insured shall be limited to the limits of liability -re- quired by that "written contract requiring in- surance". This endorsement shall not In- crease the limits of insurance described in Sectlon III - Limits Of Insurance. b) The insurance provided to the additional In- sured does not apply to "bodily injury", "prop- erty damage" or"personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: I. the preparing, approving, or failing to prepare or approve, maps, shop draw- Ings, opinions, reports. surveys, field or- ders or change orders, or the prepadng, approving, or failing to prepare or ap- prove, drawings and specifications; and R. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "buddy, Injury" or "property damage" caused by "your worl" and included in the "products -completed op- erations hazard" unless the "written contract requiring Insurance" specitcally requires you to provide such coverage for That additional Insured, and then the insurance provided to the additional insured applies only to such "bodily Injury,''or "property damage" that oc- curs before the -end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional 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 loss We - cover under this endorsement However, -if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and noncontributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named 'insured •for such loss, and we wig not share with that "other Insurance". But the Insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the adrti- tional insured when that person or organization Is an additional Insured under such "other insur- ance". 4. As a condition 'of coverage provided to the additional insured by this endorsement: a) The additional Insured must give us written notice as soon as practicable of an — occur-rence or an offense which may result in a claim. To the extent possible, such notice should Include: '-CG-D246091)6C920tf5TheSC'fTauiTravelers-Cofnpan(es; lnc. - "'--p'agel oft - oiawr insured A-1 Chipseal Company Policy Number. DT00019OP673 COMMERCIAL GENERAL LW,J"fY I. How, when and where the "occurrence" or offense took place; ir. The names and addresses of any injured persons and witnesses, and W. The nature and location of any injury or damage arising out of the "occurrence" ar Offense. b) if a claim Is made or "suit" is brought against the additional Insured, the additional. insured must: L immediately record the specifics of the claim or "suit" and the date receiver; and fi..Notify us as seen as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit"; cupperate with us in the investigation or settlement of the claim or defense against the •suit", and otherwise comply with all policy conditions_ d) The additional insured must tender the de- fense and Indemnity of any claim or "SUh" to any provider of 'other insurance" which would cover the additional Insured for a loss we cover under this endorsement. However, this condition does not effect whether the insur, anoe provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insrtred as described in paragraph 3. above. 5. The following definition is added to SECTION V. DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement undet which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- cum and the *personal injury" is caused by an offense committed: a. Afterthe signirig and execution ofthe contract or agreement by you; b. While that part of the' contract or agreement Is in effect; and C. Before the end of the policy period. _• "' Page 2 of 2 ?a 2tin -rhe a Paw vavelers Companies.Tnc= - , - - CG p2 45 o8 os - ,