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HomeMy WebLinkAbout124948 TOP GUN PRESSURE WASHING INC - INSURANCE CERTIFICATE (10)ACORO® CERTIFICATE OF LIABILITY INSURANCE DA EIMM DD YYYYI 6/20/2012 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 endorsements . PRODUCER CONTACT NAME: PHONE 7 FAXAICNo : - - 2074 Olson & Olson Ltd 5655 S. Yosemite St. #101 Greenwood Village CO 80111 E-MAIL ADDREss: 2 I n n n. m INSURER(S) AFFORDING COVERAGE NAICt INSURER A.Westfield INSURED TOPGU-1 INSURERS _Pinnacol Assurance INSURER C: Top Gun Pressure Washing, Inc. 500 W. 67th Avenue Loveland CO 80538 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 2138279935 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 ADDLTYPE OF INSURANCE INSR U D POLICY EFF POLICY EXP LTR IN POLICY NUMBER MMIDD/YYYY MMIODIYYYY LIMITS A GENERAL UMBILITY V V TRA6418137 /21/2012 /112013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE To ""T�D PREMISES Ea mcunenca $100.000 CLAIMS -MADE L OCCUR MED EXP Any One person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGO $2,000,000 POLICY X PRO- LOC $ A LI V TRA6418137 /21/2012 /1/2013 Eaaccitlenq $1,000000 INJURY(Per person) $ NVAUTOBODILY LLOWNESCHEDULEDUTOSAUTOSBODILY FMOBIDABILITYLE INJURY (Per accident)$ I REDAUTOS X NAOTOSWNED PROPERTY DAMAGE $ A X UMBRELLA LIAR X OCCUR TRA6418137 6/21/2012 7/1/2013 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAR CLAIMS -MADE DED XI RETENTION SO 1 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYER YIN y 14031609 7/1/2012 X WC STATU- OTH- E.LEACHACCIDENT 57,000,000 ANV PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? V❑ NIA �/1/2013 E.L. DISEASE -EA EMPLOYE 31,00Q000 (Myandatory in NH) UDESCRIPTION OF OPERATIONS Prices EL. DISEASE -POLICY LIMIT _ I S1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Afton ACORD 101, Additional RernI Schedule, f rr,ore apace is required) Contract Work. The City, its officers, agents and employees are included as Additional Insured as required by written contract as respects General Liability per form CG3227 06/10 attached and Automobile Liability per form CA7078 09111 attached. General Liability & Workers' Compensation includes Waiver of Subrogation in favor of The City, its officers, agents and employees as required by written contract. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Department; Attn: John Stevens P.,O. Box 580 AUTIIORRED REPRESENTATIVE Fort Collins CO 80522-0580 All rirrint. roenrvnA ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 32 27 06 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COLORADO ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or agreement that such person or organization be 1. "Bodily injury", "property damage" or "personal added as an additional insured on your policy. and advertising injury" arising out of the Such person or organization is an additional rendering of, or the failure to render, any insured only with respect to liability for "bodily professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: advertising injury" caused by your ongoing a. The preparing, approving or failing to operations for the additional insured and only to prepare or approve maps, shop drawings, the extent that such "bodily injury", "property opinions, reports, surveys, field orders, damage" or "personal and advertising injury" is change orders or drawings and caused by your acts or omissions or the acts or specifications; or omissions of those performing operations on your b. Supervisory, inspection, architectural or behalf. engineering activities. A person's or organization's status as an 2. "Bodily injury" or "property damage" occurring additional insured under this endorsement ends after: when your operations for that additional insured are completed. 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. CG 32 27 06 10 © Insurance Services Office, Inc., 2010 Page 1 of 1 0 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXPANDED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE The coverage provided by this endorsement is summarized below and is intended to provide a general coverage description only. For the details affecting each coverage, please refer to the terms and condi- tions in this endorsement. A. Who Is An Insured broadened: • Additional Insured by Contract, Agreement or Permit • Legally Incorporated Subsidiaries • Newly Acquired Organizations B. Supplementary Payments • Bail Bonds - $5000 • Loss of Earnings - $500 C. Fellow Employee Exclusion Amendment D. Coverage Extensions • Transportation Expenses • Personal Effects (Excess Basis) E. Additional Coverages • Expenses paid for returning a stolen covered auto • Fire Department Service Charge F. Airbag Coverage - Accidental Discharge G. Glass Repair - Waiver of Deductible H. Knowledge and Notice of an Accident, Claim or Suit I. Unintentional Failure To Disclose Hazards J. Worldwide Coverage K. Definitions • Bodily Injury Redefined In addition to the policy amendments contained in A. through K. listed above, the endorsements listed below will automatically be attached to your policy to complete the coverage provided by the Business Auto Expanded Endorsement: • Audio, Visual and Data Electronic Equipment Coverage Added Limits - CA 99 60 • Auto Loan/Lease Gap Coverage - CA 20 71 • Drive Other Car Coverage - Broadened Coverage For Named Individuals - (Executive Officers/Spouses) - CA 99 10 • Employee Hired Autos - CA 20 54 • Employees As Insureds - CA 99 33 • Hired Auto Physical Damage (Refer to Auto Declarations page) • Rental Reimbursement Coverage - CA 99 23 • Waiver of Transfer of Rights of Recovery (Waiver of Subrogation) - CA 04 44 A. WHO IS AN INSURED BROADENED SECTION II - LIABILITY COVERAGE, item A. Coverage, 1. Who Is An Insured is amended to include the following additional para- graphs: d. Any legally incorporated subsidiary of yours in which you own more than 50% of the voting stock on the ef- fective date of this endorsement. However, "insured" does not include any subsidiary that is an "insured" under any other liability policy or would be an "insured" under such a policy but for its termination or the exhaustion of its limit of insurance. Coverage under this provision is af- forded only for the first 180 days af- ter you acquire or form the organization or until the end of the policy period, whichever comes first. e. Any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership or a majority in- terest. However, coverage under this provision: CA 70 78 09 11 Page 1 of 3 (1) Does not apply if the organiza- tion you acquire or form is an "insured" under another auto li- ability policy or would be "in- sured" under such a policy but for its termination or the ex- haustion of its limits of insur- ance; (2) Does not apply to "bodily injury" or "property damage" that oc- curred before you acquired or formed the organization; and (3) Is afforded only for the first 180 days after you acquire or form the organization or until the end of the policy period, whichever comes first. f. Any person or organization with whom you agreed in writing in a contract, agreement or permit, to provide insurance such as is af- forded under this policy. This provision only applies if the written contract or agreement has been executed or permit has been issued, prior to the "bodily injury" or "property damage". B. SUPPLEMENTAL PAYMENTS SECTION II - LIABILITY COVERAGE, item A. Coverage, 2. Coverage Extensions, a. Sup- plementary Payments, subparagraphs (2) and (4) are deleted and replaced with the follow- ing: (2) Up to $5,000 for cost of bail bonds (including bonds for re- lated traffic law violations) re- quired because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses in- curred by the "insured" at our request, including actual loss of earnings up to $500 per day be- cause of time off from work. C. FELLOW EMPLOYEE EXCLUSION AMEND- MENT SECTION II - LIABILITY COVERAGE, item B. Exclusions, 5. Fellow Employee does not ap- ply if the "bodily injury" results from the use of a covered "auto" you own or hire. D. COVERAGE EXTENSIONS We will pay up to $100 per day to a maximum of $1,800 for transporta- tion expense incurred by you be- cause of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". The following is added to Item 4. Cover- age Extensions: c. Personal Effects We will pay up to $500 for the "loss" of your personal effects that are contained in a covered "auto" due to the total theft of the covered "auto." We will pay only for those personal effects that are contained in covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage. Our payment for "loss" of or damage to personal effects will apply only on an excess basis over other collect- ible insurance. E. ADDITIONAL COVERAGES SECTION III - PHYSICAL DAMAGE COVER- AGE, A. Coverage, is amended to include the following additional coverage items: 5. We will pay the expense of returning a stolen covered "auto" to you. 6. Fire Department Service Charge When a fire department is called to save or protect a covered "auto", its equip- ment, its contents or occupants from a Covered Cause Of Loss, we will pay up to $1,000 for your liability for Fire De- partment Service Charges: (a) Assumed by contract or agreement prior to loss; or (b) Required by local ordinance. No deductible applies to this additional coverage. F. AIRBAG COVERAGE - ACCIDENTAL DIS- CHARGE SECTION III - PHYSICAL DAMAGE COVER- AGE, Item A. Coverage, 4. Coverage Exten- SECTION III - PHYSICAL DAMAGE COVER- sions, a. Transportation Expenses is replaced AGE, Item B. Exclusions, subparagraph 3.a. with the following: is deleted and replaced with the following: a. Transportation Expenses a. Wear and tear, freezing, mechanical or electrical breakdown. CA 70 78 09 11 Page 2 of 3