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HomeMy WebLinkAboutU S A CONSTRUCTION INC - INSURANCE CERTIFICATEClient#: 56403 8USACONSI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 5/18/2/DDIYVYY) /18/2012 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 AME: Susan Salazar N Willis of Colorado, Inc. PHONE 303-996-6733 EAX 720-524-0130 A/D No Ext :INCX, No 2000 South Colorado Boulevard ADDRESS: susan.salazar@willis.com Tower II, Suite 900 INSURER(S) AFFORDING COVERAGE NAIC JI Denver, CO 80222 INSURER A: Mountain States Insurance Group 5900 INSURED INSURERS Plnnacol Assurance 41190 U.S.A. Construction, Inc P.O. Box 325 INSURER 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. LTRR TYPE OF INSURANCE NSRL SUBR MD POLICY NUMBER MMIUI�fYYYY MMIIDYYYP LIMITS A GENERAL UABIUTY CPP0075152011 2/01/2012 0210112013 EACH OCCURRENCE $1,000000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR PDAMAREMGEToRENTTEance 8100000 MED EXP (Any me person) $1 O 000 PERSONAL BADVINJURY $1,000,000 All #UND6180311 X GENERAL AGGREGATE $2,000,000 GATE 'L AGGRATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 IGEN POLICY X PRO ECT LOC $ _ A AUTOMOBILE LIABILITY BAP007515211 2/01/2012 02/01/2013 Ea BINEDI.denSINGLELIMIT $1,000,000 BODILY INJURY(Per person) $ALL ANY AUTO IX OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per amident) $ PROPERTYDAMAGE Pere dent $ HIRED AUTOS X NON -OWNED AUTOS $ A 1( UMBRELLA LIAB OCCUR UMB007515211 2/01/2012 02/01/2013 EACH OCCURRENCE $1 000000 AGGREGATE $1,000,000 EXCESS LIAR CLAIMS -MADE DED X RETENTION$0 $ _ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE � OFFICERIMEMBER EXCLUDED' NIA 4027969 4/01/2012 04/01/2013 WC STATU- OTH- X T RV LIMI ft E. L. EACH ACCIDENT $1,000000 EL DISEASE -EA EMPLOYEEI $1,000,000 IJ (Mandatory in NH) If yes, describe ender DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $1,000,000 A Scheduled Eqpt CPP0075152011 2/01/2012 02/01/2013 Per Schedule, $500 Ded Lease/Rented Eqpt $160,000, $500 Ded DESCRIPTION OF OPERATIONS I LOCATIONS I 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) rifi LIUMMAn City of Fort Collins P.O. Box 580 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 (2010105) 1 of 2 #S936299/M934664 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 8RSM1 SAGITTA 25.3 (2010105) 2 of 2 #S936299/M934664 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 Bail 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 B. Newly Formed or Acquired Organ¢ations Included 10. Legal Liabirity 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 $16,000 13 Property Damage for Tools Loaned to You $10,000 14. Revisions to Definitions "Insured Contract" Amended Included "Mobile Equipment" Amended Included "Specified Perils" Added Included "Water Damage" Added 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 (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 [eased to you by such person(s) or organization(s), 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 11 - WHO IS AN INSURED is emended 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 damago", or"personal and advertising injury" caused, in whole 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 II - WHO IS AN INSURED is amended to Include as an insured any state or governmental agency or subdivision or_poiltleal 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 a 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