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Home My WebLink AboutUSA CONSTRUCTION INC - INSURANCE CERTIFICATEClient#: 56403 8USACONSI ACORD,. CERTIFICATE OF LIABILITY INSURANCE .ATE 1/30/2IDD/YYYY) /30I2012 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: Virginia (Ginny) Shaw` Willis of Colorado, Inc. (PHONE a Ex1: 303.765-1572 _ ac, No : 720-524-0130 c 2000 South Colorado Boulevard E-MAIL - Tower II, Suite 900 ADDRESS: Denver, CO 80222 COVERAGE NAICN n States InsuranRDINGce INsuRERA: Mountain States Insurance Group 5900 INSURED INSURER B : Plnnacol Assurance 41190 U.S.A. Construction, Inc P.O. Box 325 NSURER C Timnath, CO 80547 INSURER D: 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. INSR LTR TYPE OF INSURANCE ADDLSUB INSR MD POLICY NUMBER POLICY EFF (MM/DD)`YYYY POLICY UP Mill LIMITS A GENERAL LIABILITY CPP0075152011 2/01/2012 02/01/2013 EACHOCCURRENCE$1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR PREMISESOEaoiiun°ence $100000 MED UP (Any one Person) $1 O 000 PERSONAL B ADV INJURY $1,000,000 X A/I #UND618 0311 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO JECT LOC PRODUCTS - COMPIOP AGG $2,000,000 $ A AUTO MOBILE LIABILITY BAP007515211 2/01/2012 02/0 //201 COMBINED SINGLE LIMIT Ea accidenlJ $ 1,000,OOD X BODILY INJURY (Per Person) _ $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Perident accident) $ X PROPERTY DAMAGE Per accident $ HIRED AUTOS X NON -OWNED AUTOS A X UMBRELLA LIAB I X OCCUR UMB007515211 2/01/2012 02/01/201 EACHOCCURRENCE $1,000,000 AGGREGATE $1000000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION$O $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? N / A 4027969 4/01/2011 04/01/2012 X T WCSTA,,j OTH- RV Mt ER_ EL EACH ACCIDENT $1 OOO OOO �, E.L. DISEASE- EA EMPLOYEE $1.000 000 (Mandatory in NH) If yes, descnW under DESCRIPTION OF OPERATIONS below ' E.L. DISEASE -POLICY LIMIT $1,000,000 A Scheduled Eqpt CPP0075152011 2/01/2012 02101/2013 Per Schedule, $500 Ded Leased/Rented Eqp $160,000,$500 Ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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 Additional Insureds. (See Attached Descriptions) City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE Via H. Aaw V 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD #S898698/M898551 8RSMI 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 (2010/051 2 #S898698/M898551 UND 618 03 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MS -EDGE GENERAL LIABILITY ENDORSEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SUMMARY OF COVERAGE EXTENSIONS Extension Limit 1. Supplementary Payments - Increased Limits Sail Bonds $3,000 Loss of Earnings $1,500 2. Miscellaneous Additional Insureds Mortgagee, Assignee or Receiver Included Managers or Lessors of Premises included Controlling Interest Included Co -Owner of Insured Premises Included Owners or Other Interest From Whom Land Has Been Leased Included Lessor of Leased Equipment Included Owners or Contractors for Whom You are Performing Ongoing Operations Included State or Governmental Agency or Political Subdivision Included 3. Aggregate Limits of Insurance for Single Construction Projects General Aggregate Limit 4. Revisions to "Who Is An Insured" Volunteer Workers Expanded Included 5. Expanded "Expected or Intended Injury" Definition Included 6. Knowledge of Occurrence, Offense, Claim or Suit Included 7. Unintentional Omissions in Disclosure Included 8. Waiver of Subrogation by Contract or Agreement Included 9. Newly Formed or Acquired Organ¢ations Included 10. Legal Liability for Damage to Premises Rented to You (Specified Perils) $300,000 11. Non -Owned Watercraft Up to 51 Feet in Length Included 12. Medical Payments Revised $15,000 13 Property Damage for Tools Loatted to You $10,000 Revisions to Definitions "Insured Contract" Amended "Mobile Equipment" Amended "Specified Perils" Added "Water Damage" Added Included Included Included Included The above is a summary of provisions in this endorsement. Please consult the specific provisions below for complete wording contained in these endorsement provisions. The endorsement provisions shall prevail in the event of a conflict between the summary and the following endorsement provisions. ENDORSEMENT PROVISIONS The provisions of the Commercial General Liability Coverage Part apply except as otherwise provided in this endorsement. This endorsement applies only if such Coverage Part is included In this policy. Includes copyrighted material of Insurance Services Office, Inc., with Its permission UND 618 03 11 Page 1 of 8 UND 618 03 11 1. SUPPLEMENTARY PAYMENTS - INCREASED LIMITS - SECTION 1 - COVERAGES, SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is amended as follows: A. The limit shown in 1.b. for the costs of hail bonds Is Increased to $3,000. B. The limit shown in 1.d. for all reasonable expenses incurred at our request, including actual loss of earnings because of time off work, is increased to $1,500. 2. MISCELLANEOUS ADDITIONAL INSUREDS SECTION II - WHO iS AN INSURED is amended to Include as an insured any person or organization (known as additional insured) described In paragraphs (1) through (8) below, whom you are required to add as an additional Insured on this policy under a written contract or agreement. The written contract or agreement must be: A. Currently in effect or becoming effective during the term of this policy; and B. Fully executed by you and the additional insured prior to the "bodify injury", "property damage" or "personal and advertising Injury", but only the following persons or organizations are additional insureds under this endorsement, and coverage provided to such additional insureds is limited as provided herein. (1) ADDITIONAL INSURED -MORTGAGEE, ASSIGNEE OR RECEIVER SECTION II - WHO IS AN INSURED is amended to Include as an insured any person or organization with respect to their liability as a Mortgagee, Assignee or Receiver and arising out of the ownership, maintenance, or use of the premises by you and shown in the Schedule of All Locations You Own, Rent or Occupy. a. This insurance does not apply to structural alterations, new construction or demolition operations performed by or for that person or organization. (2) ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES SECTION 11 - WHO IS AN INSURED is amended to include as an insured any person or organization with respect to their liability as a Manager or Lessor of premises and arising out of the ownership, maintenance or use of that part of the premises leased to you and shown In the Schedule of All Locations You Own, Rent or Occupy, and subject to the following additional exclusions: a. This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises; (2) Structural alterations, now construction or demolition operations performed by or for that person or organization. (3) ADDITIONAL INSURED - CONTROLLING INTEREST SECTION II - WHO IS AN INSURED Is amended to include as an insured any person or organization with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain or control while you lease or occupy these premises. This Insurance does not apply to structural alterations, new construction or demolition operations performed by or for that person or organization. (4) ADDITIONAL INSURED - CO.OWNER OF INSURED PREMISES SECTION II - WHO IS AN INSURED is amended to Include as an insured a co-owner of the insured's premises with respect to their liability arising out of their liability as co-owner of such premises. (5) ADDITIONAL INSURED - OWNERS OR OTHER INTEREST FROM WHOM LAND HAS BEEN LEASED SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the land leased to you and shown in the Schedule of All Locations You Own, Rent or Occupy, and subject to the following additional exclusions: a. This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to lease that land; (2) Structural alterations, new construction or demolition operations performed by or for that person or organization. Includes copyrighted material of Insurance Services office, Inc., with its permission UND 618 03 11 Page 2 of 8 UND 618 03 11 (6) ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT SECTION II - WHO IS AN INSURED Is amended to include as an insured any person or organization with respect to their liability arising out of the maintenance, operation or use by you of equipment leased to you by such person(s) or organization Is), subject to the following additional exclusions: a. This insurance does not apply: (1) To any "occurrence" which takes place after the equipment lease expires; (2) To "bodily injury" or "property damage" arising out of the sole negligence of that person or organization. (7) OWNERS OR CONTRACTORS FOR WHOM YOU ARE PERFORMING ONGOING OPERATIONS SECTION II - WHO IS AN INSURED is amended to include as an insured: a. Any person or organization for whom you are performing operations but only with respect to liability for "bodily Injury", "property damage", or "personal and advertising injury" caused, in w hole or in part, by: (1) Your acts or omissions; or (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 provision 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 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. (8) ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR POLITICAL SUBDIVISION SECTION 11 - WHO IS AN INSURED is amended to include as an insured any state or governmental agency or subdivision or political subdivision, subject to the following additional provision: This insurance applies only with respect to the following hazards for which the state, governmental agency or subdivision or political subdivision has issued at permit in connection with premises you own, rent or control and to which this insurance applies: a. The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations or similar exposures; or b. The construction, erection, or removal of elevators; or c. The ownership, maintenance, or use of any elevators covered by this insurance. With respect to coverage provided by this provision 2. MISCELLANEOUS ADDITIONAL INSUREDS, the following additional provisions also apply: Includes copyrighted material of Insurance Services Office, Inc., with its permission UND 618 03 11 Page 3 of 8