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HomeMy WebLinkAbout105704 CHURCHICH RECREATION LLC - INSURANCE CERTIFICATE (3)Client#: 75956 CHURRECR ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIVYVY) s/01/2011 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 Bobbi J McGee NAME: HUB International Ins Svcs Inc PHONE 720-207-2363 F"x 866-243-0727 AIC NO Eat : (AIC, No 1125 17th Street, Suite 900 E-MAIL V ADDRESS: g ee bobbi.mc hubinternational.com Denver, CO 80202 VKUUULLK 303 694-0940 D CUSTOMER ID M 0sk INSURERIS) AFFORDING COVERAGE NAIC # INSURED INSURER A: Employers Mutual Casualty Compa 21415 Churchich Recreation, LLC INSURER B: General Star Indemnity Company 37362 Recreation Equipment Installers Inc INSURER C -Hartford Insurance Company of M 37478 PO Box 1174 INSURER D: EMC Insurance Companies 25186 Niwot, CO 80544.1174 INSURER E CA Resident License #0757776 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 A DL UBR POLICY NUMBER '.POLICY EFF iMM/DD/VVYY POLICY EXP MMIDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X PD Ded:500 3D4820710 EACH OCCURRENCE $1000000 DAMAGE T R NTED PREMISES Eaoccunence s300,000 MED EXP (Any one person) $5,000 PERSONAL fl ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATELIMIT APPLIEG PER: POLICY X PRO_ RO LOC PRODUCTS-COMP/OP AGG $2,000,000 $ D AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 3E4820710 '01115I2011 01I151201 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ B X UMBRELLAuae E%CESS LIAB X OCCUR CLAIMS -MADE IXG403867D 03/23/2011 03/23/201 'EACHOCCURRENCE 11,100001 AGGREGATE $11000 0O0 HDEDUCTIBLE RETENTION $ O $ X 1 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 34WECRF3623 '09/25/2011 09/25/201 X WC STATU- OTH- E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE -POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Project: 7232 City Park Mini Shelters Certificate Holder is included as Additional Insured in regards to the General Liability. Coverage is (See Attached Descriptions) City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Purchasing Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 280 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) 1 of 2 The ACORD name and logo are registered marks of ACORD ffS13024R3IM13023QQ conA DESCRIPTIONS (Continued from Page 1) primary and non-contributory basis as respects General Liability. Per project aggregate applies to the General Liability. r�nm ce.e %wvmwI G VIA #513024831M13023g9 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - CONSTRUCTION CONTRACTS - VICARIOUS LIABILITY This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION 11 — WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are performing operations when you 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, in whole, by: 1. Your acts ui umissiuns, ur 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. 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. °Bcdity injury," "property damage' or "personal and advertising injury" resulting from any act or omission by, or willful misconduct of the additional insured, whether the sole or a contributing cause of the loss. The coverage afforded to the additional insured is limited solely to the additional insured's "vicarious liability' that is a specific and direct result of your conduct_ 'Vicarious liability" as used in this endorsement means liability that is imposed on the additional Insured solely by virtue of Its relationship with you, and not due to any act or omission of the additional insured. 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 ser- vice, maintenance or repairs) to be performed by or on behalf of the additional insureds) 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 subcon- tractor engaged in performing operations for a principal as a part of the same project. 3. 'Bodily injury," "property damage" or 'personal and advertising injury' arising out of the rendering cf. or failure to render, any profes- sional, architectural, engineering or surveying seiviues includiriy. a. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. C. The limits of insurance applicable to the additional insured are those specified in the Declarations of this policy or in the written contract or written agreement, whichever is lower. D. Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether that insurance is primary, excess, contingent or on any other basis, unless you and the additional insured have specifically agreed in a written contract or written agreement that this insurance be primary_ When coverage is provided on a primary basis we will not seek contribution from any other insurance available to the additional insured if a written contract or written agreement requires that this insurance be noncontributory. E. All other terms and conditions of this policy remain unchanged. CG7482(1-08) Includes copyrighted material of ISO Properties, Inc. wtdt itspermission. Page 1 of 1 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or 'your work' done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 06 09 ® Insurance Services Office, Inc., 2008 Page 1 of 1 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT — AGGREGATE LIMITS OF INSURANCE (PER PROJECT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The General Aggregate Limit under LIMITS OF INSURANCE (Section III) applies separately to each of your projects away from premises owned by or rented to you. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Form CG7429 (Ed. 11-98) Copyright, Insurance Services Office, Inc., 1984 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - CONSTRUCTION CONTRACTS INCLUDING COMPLETED OPERATIONS -VICARIOUS LIABILITY This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION 11 — WHO IS AN INSURED is amended to include as an additional insured any person or organization when you 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, in whole, by: 1. Your acts or omissions, or 2. The acts or omissions of those acting on your behalf; in the performance of: a. your ongoing operations for the additional insured; or b. "Your work' for the additional insured and included in the "products — completed operations hazard". 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" resulting from any act or omission by, or willful misconduct of the additional insured, whether the sole or a contributing cause of the loss. The coverage afforded to the additional insured is limited solely to the additional insured's "vicarious liability" that is a specific and direct result of your conduct. "Vicarious liability" as used in this endorsement means liability that is imposed on the additional insured solely by virtue of its relationship with you, and not due to any act or omission of the additional insured. 2. "Bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering of, or 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. C. The limits of insurance applicable to the additional insured are those specified in the Declarations of this policy or in the written contract or written agreement, whichever is lower. D. Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether that insurance is primary, excess, contingent or on any other basis, unless you and the additional insured have specifically agreed in a written contract or written agreement that this insurance be primary. When coverage is provided on a primary basis we will not seek contribution from any other insurance available to the additional insured if a written contract or written agreement requires that this insurance be noncontributory. E. All other terms and conditions of this policy remain unchanged. CG7482.3(1-08) Includes copyrighted material of ISO Pmoerties. Inc. with its permission. aano 1 nt 1 HUB' ,intarna�anal The certificate of insurance we have issued on your behalf has changed from previous forms. ACORD, the insurance industry standards leader for Forms, updated the Certificate of Insurance Form 25 in May 2011. Regulations require that agencies use current versions of ACORD. The new form is different from previous versions regarding the "notice of cancellation" clause provided to the certificate holder. Why was this change necessary? • To align the certificate with the policy contract. Cancellation provisions are rights under the policy and are not voluntary provisions that we can alter. Policy forms must be approved by the state department of insurance by law. We are often asked to alter the certificate, or to issue proprietary certificates provided by the certificate requestor. However, there are a number of reasons we are unable to comply with these requests: • ACORD forms are copyrighted, and can only be used in the ways permitted by their licensing agreement, which states that they cannot be used after new forms have been released. • Any document that promises a policy right is considered a policy form. Policy forms must be approved by the state department of insurance by law. • Notice of cancellation is a policy right, not an unregulated service. No insurer shown on this certificate is able to provide the cancellation notice you desire by endorsement. For example, the insured can cancel immediately, so it would be impossible for the insurer to give you the notice you request. State law also grants the insurer the right to cancel for reasons such as nonpayment with less notice than you require. • Knowing that we cannot give notice under certain circumstances, giving a certificate promising notice would consist of misrepresentation or fraud, which could subject our agency and staff to civil and criminal penalties. • Our insurance company contracts only allow us to issue unaltered ACORD forms. Many proprietary certificates include broad, vague, or ambiguous language that may or may not be in compliance with state laws, regulations, and insurance department directives. Therefore, we cannot issue any proprietary certificates that have not been reviewed by our state insurance department. We appreciate your understanding of the legal restrictions on our ability to comply with your request.