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Home My WebLink About389648 A-1 CHIPSEAL COMPANY - INSURANCE CERTIFICATE (8)Client#: 53076 8A1 CHIPS ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE /27/2011 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 FAX 303.722-8862 AIC, No, Ex[): AIC, No 720 South Colorado Boulevard E-MAIL ADDRESS: Suite60ON INSURERS) AFFORDING COVERAGE NAIC# Denver, CO 80246 Travelers IndemnityCompany INSURER A: •y P Y 25658 INSURED INSURERS: Travelers Property Casualty Corn 36161 A-1 Chipseal Company Assurance 41190 DBA Rocky Mountain Pavement, LLC INSURER GPinnacol INSURER D 2001 West 64th Lane 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 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 ADDILSUBA INSR MD POLICY NUMBER POLICY EFF MM/DD"YY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CGD2460805 X DTC0019OP673 10/01/2011 10/01/2012 EACH OCCURRENCE $11000000 PREMISES (Ea oocu ence) $300 000 MED EXP (Any one person) $10,000 PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JPRO LOC COMP/OP AGO $2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULEDAUTOS AUTOS HIRED AUTOS X NONOWNEDAMAGE AUTOS Ix DT8100190P673 10/01/2011 10101I201 COMBINEDINGLELIMIT $1,000,000 RY (Per person) ifl $ RY(Peraccidem) $ $ B x UMBRELLA LIAS EXCESS LIAB X OCCUR CLAIMS -MADE DTSMCUP0190P673 10/01/2011 10/01/2012 EACH OCCURRENCE $10000000 AGGREGATE $10 000 000 DED I X RETENTION510000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICEWMEMBER EXCLUDED? (Mandatory in NH) If yes, desGlhe under DESCRIPTION OF OPERATIONS below N I A 4055760 10/01/2011 10/01/201 X WC STATU- OTH- .T.ORY LIMITS I IER $500,000 E.L. EACH ACCIDENT E L. DISEASE - EA EMPLOYEE 5500 000 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: 7256 Hot Applied Chipseal Overlay 2011 The following are Additional Insureds as respects General Liability only if required by written contract and coverage applies only as respects ongoing operations performed by the Insured for the (See Attached Descriptions) City of Fort Collins 300 Laporte Ave 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 V IUBti-ZUIU ACUKU CUKPUKAI ION. All rights reserved. ACORD 25 (2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD #S859054/M858744 8RSMI 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. .s . i i s u.a knu iuluul L OIL #S859054/M858744 Insured. A-1 Chipseal Company Policy Number: DTC0019OP673 Gu AMERCIAL GENERAL LIAMUTY THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ iT CAREFULLY 13LANKET ADDiTIONAL INSURED {C®N e tC_1 0.RS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL. LMUTY COVERAGE PART 1. 2- WHO IS AN INSURED — (Sectlon IQ is amended to include any person or mganizaUon that you agree to a "written contract requiring Insurance" to include as an additional insured on this cover- age Part, but a) Only with respedto tlahtllty for "bodily injury', . -property damage° or'personal injury'; and b) If, and only to the extent that, the injury or damage is caused-hy 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 quality as an ad Monal Insured with respect to the Independent ads or omissions of such person or organization. The insurance provided to the addifionai Itstir'ed by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability regclred*by the "written contract requiring insurance°, the in- surance provided to the additional insured shall be limited to the limits of gabi6ty-ne- quired by that % Men contract requiring in- surance". This endomineat shall not fit -- crease the limits of Insurance described in • section 10 — Limits Of I nsurance. b) The insurance provided to the adddloral In- sured does not apply tQ "bodily injury°,'prop- arty damage° or'personal injury" arising out of the rendering of, at failure to render, any professional amhibetaural, engineering or sur- veying services, including: L The preparing, approving, or failing to prepare or approve, maps, shop draw- Ings, opinions, -reports, surveys, field or- ders or change orders, or the preparing, approving, or falling to prepare or ap- prove, drawings and spe0fica5ors., and R Supervisory, Inspection, afchiteclural or engineering activities, c) The insurance pmVided to the additional in. sured does not apply to "bodily injury" or `property damage" caused by "your work" and included in the "produdstompleted op- erations hazard' unless the 'Y+rillen contract requiring insurance" specifically requires you to provide such caverage for that additional Insured, and then the insurance provided to the additional insured applies only to such bodily Injuty"'or "property damage" that oc- curs before the -NA of the period of time for Which the '*Man coritract requ ring insur- ance" requires you to provide such coverage or the end of the policy Wad, whichever Is earlier. 3- The Insurance provided to the additional insured by ibis 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 Howaver if the "written contract requiring insurance" speol8rally requires that this insurance apply on a primary basis or a printery and non-corrftffer ny basis, this insurance is primary to 'other instrience" avagable to the additfional insured which covers that person or organization as a named insured -for such loss, and we will not share with that 'ether insurancu'. Put the htsurance provided to the additional insured by this eridorsurnerrt still is excess over any valid and collectible "other in- surance, whether primary, excess, contingent or on any other basis. that is avalabie to the ad& tional insured when that person or organization is an addldonai insured under such "other insar- anne'. _ 4_ As a condition 'of coverage provided to the additional insured by Uric endorsement; a) The additional Insured must give us vmiten notice as soon as practicable of an "arxnr- ranori- or an offense which may result Tn a claim. To the extent possible, such rtatioe should Include: '—CU7A246-0FW ca320ll>1-fie t'trairiTiavelersCompariles;lric- --'--'EageioPi "-- otam Client#: 53076 8A1 CHIPS ACORDTM CERTIFICATE OF LIABILITY INSURANCE D 9/27/2IDWYYYY) /27/zo11 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 FAX 303.722-8862 A/C, No, Et : A/C, No 720 South Colorado Boulevard E-MAIL ADDRESS: Suite 60ON INSURERIS) AFFORDING COVERAGE NAIL # Denver, CO 80246 INSURERA: 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 INSURER O: 2001 West 64th Lane 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 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 OFINBURANCE ADDLSUBF INSR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY) POLICY EXP (MMIDD/YYYY)_ LIMITS A GENERAL LIABILITY DTC0019OP673 10/01/2011 10/01/201 EACH OCCURRENCE $1000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE aOCCUR PREMISES Ea occu rea $300 000 MED EXP(Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 CGD2460805 X GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATELIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $2,000,000 POLICY X PRO- ECT LOC $ B AUTOMOBILE LIABILITY DT810019OP673 0/01/2011 10/01/201 (Eaaamide°tSINGLEUMIT $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per amident) $ PROPERTY DAMAGE Per accident $ X HIRED AUTOS X NON -OWNED AUTOS B X UMBRELLALIAB X OCCUR DTSMCUP019OP673 10/01/2011 10/01/2012 EACH OCCURRENCE $10000000 AGGREGATE $1 O 00O 000 EXCESS UAB CLAIMS -MADE DED I X I RETENTION $10000 $ _ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? N I A 4055760 10/01/2011 10/01/2012 X WCSTATU- OTH- T RV LIMIT E.L. EACH ACCIDENT $SOO OOO E.L. DISEASE - EA EMPLOYEE $500000 (Mandatory in NH) If yes, desaioe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / 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 fl 19AA-9n1n ACr1R❑ Cf1RPnPATInN All rinhfa --nd ACORD 25 (2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD #S859053/M858744 8RSMI 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. OAUI I I A Z0.3(LUl UMD) Z otL #S859053/M858744 Insured A-1 Chipseal Company Policy Number. DTC0019OP673 Cal MERCIAL GENERAL UABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY 13LANKET ADDITIONAL INSURED (C®N 0 RAP 11 CSRS) This endorsement modifies insurance provided undertho following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Serflon IQ Is amended c) The insurance provided to the additional In- to include any person or prgantmion that you sured does not apply to "baddy Injury" or agree in a "written contract requiring Insurance" "property damage° caused by "your work" to Include as an additional insured on this Cover- and included in the "products -completed op - age Part, but emgons hazard" unless the 'ivlftten contract a) Only with respect to liability for "bodily injury°, requiring insurance" specifically requires you damage" or "persumal injury'; and to provide such coverage for that additional ,'property Insured, and then the insurance provided to h) if, and only to the extent that, the, injury or the additional insured applies only to such damage is caused -by ads or omissions of "bodily injury -"or "property damage" that or - you or your subcordractot in the performance - curs before the rail of the period of time for Of "your work" to whloh the "written contract which the 'Written contract requiring insiu- requiring tnsuaance" applies. The person or ance' requlras you to povide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization, 3. The insurance provided to the additional insured 2. The insurance provided to the additional Insured by this endorsement is excess over any valid and by this endorsement is limited as follows: cpttarGpfe "other insurance", whether primary, , a) In the event that the Limits of insurance of excess, contingent or on any other basis, that Is �= this Coverage Part shown in the Reciamtions available to the additional Insured fot a toss we - exceed the limits of Ilabidy, required by the cover under this endorsement However, -if the - "written contract requiring insurance", the in- 'Witon contract requiring insurance" specifically sumnce provided to the additional insured requires that this insurance apply on a primary A shall be limited to the limits of liabihty-m- basis or a primary and non-contributory basis, — quired by that written contract requiring In- this insurance is primary to "other insurance" surance°. This endorsement shall not in- available to the addtianal insured which covers " - crease the limits of Insurance described in that person or organization as a named insured Seeuon IN -limits Of Insurance. -for such loss, and via will not share with that �= b) The insurance provided to the additional In- "other insurance". But the - the adds ionai insured by this a dnoisomeut sun is -- sured does not apply to "bodily Injury", "prop• - city damage or `personal injury" arising out excess over any valid and rmlledible 'other io_ " of the rendering of, or failure to reader, any surance•', whether primary, excess, centingent or on arty other basis, that is available to the addi. professional architectural, engineering or sor- Veylrrg services, including: tional Insured when that person or organization Is an additional Insured under such "other insar- L The preparing, approving, or falling to once. prepare or approve, maps, shop draw- logs, opatons, -reports, surveys. field ar- 4 As a condition -of coverage provided to the - dens or change orders, or the preparing, additional insured by this endorsement approving, or falling to prepare or ap- a) The additional insured nrrjst give us written prove, drawings and spedficaffons: and notice as soon as practicable of an "occur- u- Supervisory, inspection, architectural or nonce" or an offense which may result in a claim To the extent possible, such notfoe, engineering activities, should include: ' —Cr`a R2 4S-gSB6 • = ' 8 20II5'Ttje3R:'FauTTiavelers companies; Tnc_ - _ _ ' - - -Rage f ofz "_ ore®r