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HomeMy WebLinkAbout432111 ALLIED INSULATION - INSURANCE CERTIFICATE (2)M -1 ® AFRO CERTIFICATE OF LIABILITY INSURANCE DATEIMWDDIYYYV) DW....2 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 endomement(s). PRODUCER ACT Risk services Central, Inc. Southfield MI office CONTACT NAME: PHONE (86fi) 283-7122 FAIL (84]) 953-5390 INC. No. E,q: NC. No.): EMAIL ADDRESS: 3000 Town Center suite 3000 Southfield MI 48075 USA INSURERS) AFFORDING COVERAGE HAIGa INSURED INSURER A: Old Republic Ins Co 24147 Builder services Group, Inc. d/b/a Allied insulation A Masco Corporation Company INSURER B: ACE American Insurance Company 22667 INSURER C: indemnity Insurance Co of North America 43575 Fort 5 College Ave. Fort Collins CO 80525 USA INSURER 0National union Fire Ins Co of Pittsburgh 19445 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570046271142 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. Limits shown are as requested IT, TYPE OFINSURANLE INSR MePOLICY NUMBER PQUCYEFF MMIDDIYYYY Mw0 LIMITS A GENERAL LIABILITY MwZY EACHOOCURRENOE $2,000,000 % COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $2,000,000 CLAIMS -MADE X❑ OCCUR MED UP (Anyone person) $25,000 PERSONAL &ADV INJURY §2,000,000 GENERAL AGGREGATE $5,000,000 ATE GENL AGGREGLIMIT APPLIES PER: PRODUCTS -CONPIOP ADD $10,000,000 PR F % POLICY LOG A AUTOMOBILE LIABILITY MWTB 18398-12 06/30/2012 06 30 2013 COMBINED SINGLE LIMB §5, 000 000 BODILY INJURY( Per person) % ANY AUTO BODILY INJURY (Per aoOrmn ALL OWNED SCHEDULED AUTOS AUTOS % HIRED AUTOS X NON-0WNED AUTOS PROPERTY DAMAGE P PROPERTY eraorIdenn D UMBRELLALIAB X 13273190 06/30/2012 06OCCUR /30/2013 EACH OCCURRENCE $2,000,000 IDED1 EXCESS UAB CLAIMS -MADE AGGREGATE $2,000,000 RETENTION D B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANVPROPRIETORI PARTNER' EXECUTIVE OFFICEILMEMeEB EXCLUDED? (Mandatory In NH) NIA WLRC46786385 Ded - Aci WLRC46786300 Ded - CA, MA 06/30/2012 06/30/2012 06/30/2013 O6/30/2013 X I WC STATU- OTH- TORY LIMITS LE E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1, 000, 000 Iry d—Lbe ..our DESCRIPTION OF OPERATIONS belrnv EL. DISEASE -POLICY LIMIT $1, UOO. 000 B -Excess WC WCUC46786269 06/30/2U12 u0/3U/2013 Retention 52,000,000 SIR applies per policy terns & Condit ions statutory Limit Included DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddlUonal Remarks Schedule, If more spaw Is required) [Proj: RE: Project Name: City Of Fort Collins - Home Efficiency Program.] [AI: City of Fort Collins] is included as an Additional Insured with respect to the General Liability policy, as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, City Of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Amber Riley wood Street For Fort Collins Co 80522 USA %nLnieYE/J 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD i ® CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDr' ' D6 EI2DI2 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 endomemetd(s). PRODUCER AOn Risk Services Central, Inc. Southfield MI Office CONTACT NAME: PHONE PHONE (866) 283-7122 FA% (847) 953-6390 o. Eaq: - E-MAL ADDRESS: 3000 Town Center Suite 3000 Southfield MI 48075 USA INSURER(S) AFFORDING COVERAGE NAIL R INSURED INSURER A old Republic Ins Co 24147 Builder Services Group, Inc. d/b/a Allied Insulation A Masco Corporation Company INSURER B: ACE American Insurance Company 22667 INSURER C: Indemnity Insurance CO Of North America 43575 S College A Fort Collins CO 0580525 USA Fort INSURER D: National Union Fire Ins Co of Pittsburgh 19445 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570046269776 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSR WVo POLICY NUMBER MM/DDLVV MMD LIMITS A GENERAL LLIBILITY MWZY EACHOCCURRENCE $2,000,000 % COMMERCIAL GENERAL LIABILITY PREMISES Ea ocwnence $Z, 000, 000 CLAIMSMADE X❑ OCCUR MED UP (Anyone peron) $25,000 PERSONAL B ADV INJURY $2,000,006 GENERAL AGGREGATE $5,000,000 GEHL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $10,000,000 X POLICY PRO- LOC A AUTOMOBILE LIABILITY Hers 18398-12 06/30/2012 06/30/2013 COMBINED SINGLE LIMIT $5,000,000 BODILY INJURY(P.,,Rvn) X ANY AUTO BODILY INJURY (Per amdent) ALLOWNED SCHEDULED AUTOS AUTOS NONdWNED PROPERTY DAMAGE X X HIRED AUTOS AUTOS Peramdem D BRELLALIAB x OCCUR 13273190 06/30/2012 06/30/2013 EACH OCCURRENCE $2,000,000 IDEMD EXCESSLIAB CLAIMS -MADE AGGREGATE $2,000,006 RETENTION C WORKERS ORKE SCOMABIB*ATION AND 06/30/2012 06/30/2013 X WC STATLIMITOTH Y/N DeRC4677806385 E.L. EACH ACCIDENT $1,000,000 B AHY PROPRIETOR/ PARTNER/E%ECLTNE NIA wLRC46786300 06/30/2012 06/30/2013 OFFICERIMEMBER EXCLU= IMandalogm NM Ded - CA, MA EL. DISEASE -EA EMPLOYEE $1,000,000 -V Yea, eeemee sneer DESCRIPTION OF OPERATIONS below - - E. L. UISEASE-POLICY LIMIT $1,000,000 B Excess WC IWCUC46786269 06/30/2012 06/30/2013 Retention $2,000,000 SIR applies per policy ter s & condi ions Statutory Limit Included DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (NtacN ACORD 101, Addltbml Re„urb ScLeduk, It mom apece Is requIR d) [Pro]: RE: Project Name: All Projects per written contract.] [AI: The City Of Fort Collins] is included as an Additional insured with respect to the General Liability policy, as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS. The City Of Fort Collins AMHORUED REPRESENTATIVE Fort Collins Utilities Coordinator Energy Service Program i � Coordinator iJ2£nid(cp PO Box 580 iGc4�r0 sia Fort Collins CO 80522-OSBO USA 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AC"ORO® CERTIFICATE OF LIABILITY INSURANCE DAT osr MDiDOotmyyl 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 endomement(s). PRODUCER AGO Risk Services Central, Inc. Southfield MI Office CONTACT NAME' INCC..NNo. Eat): (866) 283-7122 FAX No): (647) 953-6390 EMAIL ADDRESS: 3000 Town Center Suite 3000 INSURER(S) AFFORDING COVERAGE NAIL # Southfield MI 48075 USA INSURED INSURER A: Old Republic Ins Co 24147 Builder Services Group, Inc. d/b/a Allied Insulation A Masco Corporation Company INSURER B: ACE American Insurance Company 22667 INSURER C: Indemnity Insurance Co of North America 43575 6617 S College Ave. Fort Collins CO 80525 USA INSURER D: National Union Fire Ins Co of Pittsburgh 19445 NSURER E: INSURER F: COVERAGES CEKIIFICAIE NUMKEK: 0/UU4trZf1-0Z KEV151UN NUMKEK: 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIUD MMrDO LIMITS A GENERAL LIABILITY MWZY EACHOCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea o¢urrence $2,000,000 CLAIMS -MADE %❑ OCCUR MED EXP(Any one person) $25,000 PERSONAL B ADV INJURY $2,000,000 GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTB- LOMPIOP AGG $lO, OOO, OOO X POLICY PRO LOD A AUTOMOBILE LIABILITY MI 18398-12 06/30/2012 06/30/2013 COMBINED SINGLE LIMIT Ea accident $5,000,000 BODILY INJURY (Per person) X AWAUTO BODILY INJURY (Peraccidam) ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON-0WNED AUTOS PROPERTY PROPERTY DAMAGE D X UMBRELLAUAB X OCCUR 13273190 06/30/2012 3 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS -MADE ::: AGGREGATE $2,000,006 DED RETENTION C B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER I E%ECUTIME YIN OFFICER/MEMBER E ITJUEDP [NJNIA (Mandatory in NH) WLRC46786385 Ded - 78S WLRC46786300 Ded - CA, MA 06/30/2012 06/30/201206/30/2013 06/30/2013 WC STATu- OTH- X TORY LIMITS E.L. EACH ACCIDENT $1,000,000 I . DISEASE -EA EMPLOYEE $1,000,000 Ify describeunder DESCRIPTION OF OPERATIONS below EL. DISEASE -POLICY LIMIT $1,000,000 B EXCESS WE WCUC46786269 06/30/2012 06/30/2013 Retention 52,000,000 SIR applies per policy ter is & condi ions Statutory Limit Included DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (March ACORD 101, Additional Remarks Schedule, it more space is Required) [Proj: RE: Project Name: 215 N. Mason, job Site: 215 N. Mason, Fort Collins, Co.] [A' City Of Fort Collins] is included as an Additional Insured with respect to the General Liability and Automobile Liability policies, as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Insurance Administrator PO Box 580r�/66r� Fort Collins CO 80522 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 3 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS OR ORGANIZATIONS (MASCO FORM RR) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: The City of Fort Collins WHO IS AN INSURED (SECTION II) is amended to include a person or organization as defined above. We shall indemnify the Additional Insured for all covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured. We shall further reimburse the Additional Insured for reasonable and necessary attorneys fees and litigation costs incurred in defending against covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured, except for those attorney's fees and litigation costs paid by another insurer. Our duty to indemnify and to reimburse attorneys' fees and litigation costs shall not exceed the product derived by multiplying the total dollar amount of liability for covered damages, or the total dollar amount of attorneys' fees and litigation cost, by that percentage of legal liability attributable to the Named Insured for covered damages as determined by a trier -of -fact in an arbitration or trial. GL 319 002 0609 Masco Corporation MWZY 55525-12 Policy Period: 06-30-12 to 06-30-13