HomeMy WebLinkAbout113170 MWH AMERICAS INC - INSURANCE CERTIFICATE (2)IIIII CERTIFICATE OF LIABILITY INSURANCE
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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 Lockton Companies, LLC Denver
8110 E Union Avenue
Suite 700
Denver CO 80237
(303) 414-6000 I
L/•
CONTACT
NAME:
INC, PHONE FAX
Exl : A No
E-MAIL
ADDRESS,
DIN COVERAGE
NAIC e
INSURER A: The Travelers Indemnity Company
25658
INSURED MWH Americas, Inc.
1308383 3701ntedocken Blvd., Suite 300
Broomfield, CO 80021
2009
INSURERS: T.iai,sPropem Casualty Coaf API
25674
INSURER C: Sr. Paul Fire and Marine Insurance Company
24767
IN E ! Lexington Insurance Company
19437
NS RERE:
INSURER F :
COVERAGES MWHGL01 TX CERTIFICATE NUMBER: 3541032 REVISION NUMBER: XXXXXXX
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
ILM
TYPE OF INSURANCE
ADDL
IN
SUSR
4WD
pOLICV NUMBER
POLICY EFF
MMID
POLICY EXP
MM/ D
LIMITS
A
GENERAL LIABILITY
N
NI
VTC2KC05643BI87INDI2
8/31/2012
8/31/2013
EACH OCCURRENCE
1000000
DAMAGERENTED
300000
X COMMERCIAL GENERAL LIABILITY
CI-AIMS-MADEXOCCUR
MED EXP (Any oneperson)
Excluded
PERSONAL & ADV INJURY
s 1,000,000
GENERAL AGGREGATE
s 2,000,000
"
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
s 2,000,000
POLICY X iPEPI f I L
$
B
AUTOMOBILELIABILITY
N
N
VTC21CAP5643BO83TIL12
8/31/2012
8/31/2013
EOgBINdEeDISINGLELIMIT
s 11000,000
X
BODILY INJURY (Per person)
$ XXXXXXX
ANY AUTO
ALL OWNED AUTOSULEO
BODILY INJURY IPer accident
$XXXXXXX
X
Pe�acclEentDAMAGE
$ XXXXXXX
HIREDAUTOS X ANO-
UT03 ED
$XXXXXXX
C
X
UMBRELLA LIAB
X
OCCUR
N
N
ZUP-IIP74763-12-NF
8/31/2012
8/31/2013
EACH OCCURRENCE
s5000,000
AGGREGATE
s 5,000,000
EXCESS LIAB
CLAIMS -MADE
DIED I I RETENTIONS
S XXXXXXX
BLIMWORKERS
B
COMPENSATION
AND ANY PROPRIETORNARTNER/EXECUTIVE YIN
EXCLUDED? �
(ManMbry in NH)
N yes moon. umer
DESCRIPTION OF OPERATIONS Gebw
NIA
N
VTC2JUB5026LI8112(AOS)
VTRIU65643609512 (WI)
8/31/2012
$/31/20I2
8/312013
8/31/2013OFFICERIMEMBER
X T RYTAIN OTH-
EL. EACH ACCIDENT
s 1,000,000
E.LDISEASE EA EMPLOYEE
1000,000
E.L. DISEASE POLICY LIMIT
1000000
D
Professional Liability
N
N
015449003
10/1/2011
10/1/2012
$1000,000 each claim
$1 000,000 agERegate
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I(ANach ACORD 101, Additional Remarks Schedule, if more space la required)
Certificate Molder and any other entity are Additional Insureds as respects General Liability, Auto Liability and Umbrella Liability if required by
written contract. Coverage Is prima non-contributory, if required by written contract. Cancellation also reads: Ten (10) days for non-payment. RE:
Halligan Reservoir Enlargement. MCI Job No. 1700639.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
3541032 AUTHORIZED REPRESENTATIVE
City of Fort Collins
City of Fort Collins, Purchasing
Attn: Cliff Hoelscher
P.O. Box 580
Fort Collins, CO 80522
ACORD 25 (2010/05) (D198812010 ACORD CORPOKATION. All rights reserved
The ernwn ..ar..e ar.H 1..,... ——nlefnend m.,ka of ernwn
Named Insured: MWH Americas, Inc., MWH Constructors, Inc., MWH Global, Inc., MWH Soft, Inc. et. al.
Carrier: TRAVELERS INDEMNITY COMPANY Policy Number: VTC2KCO5643B1871ND12 Effective Dates: 8/31/12 - 8131/13
CG D2 46 08 05
Commercial General Liability
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED - (Section II) is amended to include any person or organization that you agree
in a "written contract requiring insurance' to include as an additional insured on this Coverage Part,
but:
a) Only with respect to liability for "bodily injury", "property damage' or "personal injury'; and
b) If, and only to the extent that, the injury or damage is caused by acts 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 qualify as an additional insured with
respect to the independent acts or omissions of such person or organization.
2. The insurance provided to the additional insured 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 required by the "written contract requiring insurance', the insurance provided
to the additional insured shall be limited to the limits of liability required by that "written contract
requiring insurance'. This endorsement shall not increase the limits of insurance described in
Section III - Limits Of Insurance.
b) The insurance provided to the additional insured does not apply to 'bodily injury', "property
damage" or "personal injury' arising out of the rendering of, or failure to render, any professional
architectural, engineering or surveying services, including:
I. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders or change orders, or the preparing, approving, or failing to
prepare or approve, drawings and specifications; and
ii. Supervisory, inspection, architectural or engineering activities.
c) The insurance provided to the additional insured does not apply to 'bodily injury' or "property
damage' caused by 'your work' and included in the "products -completed operations hazard"
unless the "written contract requiring insurance" specifically requires you to provide such
coverage for that additional insured, and then the insurance provided to the additional insured
applies only to such 'bodily injury" or "property damage' that occurs before the end of the period
of time for which the "written contract requiring insurance' requires you to provide such coverage
or the end of the policy period, whichever is earlier.
3. The insurance provided to the additional insured by this 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. However, if the
"written contract requiring insurance" specifically requires that this insurance apply on a primary basis
or a primary and non-contributory basis, this insurance is primary to "other insurance' available to the
additional insured which covers that person or organization as a named insured for such loss, and we
will not share with that other insurance". But the insurance provided to the
Miscellaneous Attachment : M455192
Master ID: 1308383, Certificate ID: J541032
Named Insured: MWH Americas, Inc., MWH Constructors, Inc., MWH Global, Inc., MWH Soft, Inc. et. al.
Carrier: TRAVELERS INDEMNITY COMPANY Policy Number: VTC2KCO5643B1871ND12
EFFECTIVE DATE: 08/31/12 - 08/31/13
additional insured by this endorsement still 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
when that person or organization is an additional insured under such "other insurance".
4. As a condition of coverage provided to the additional insured by this endorsement:
a) The additional insured must give us written notice as soon as practicable of an 'occurrence" or an
offense which may result in a claim. To the extent possible, such notice should include:
I. How, when and where the "occurrence" or offense took place;
ii. The names and addresses of any injured persons and witnesses; and
III. The nature and location of any injury or damage arising out of the 'occurrence' or offense.
b) If a claim is made or "suit' is brought against the additional insured, the additional insured must:
I. Immediately record the specifics of the claim or "suit' and the date received; and
ii. Notify us as soon as practicable.
The additional insured must see to it that we receive written notice of the claim or "suit' as soon
as practicable.
c) The additional insured must immediately send us copies of all legal papers received in connection
with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense
against the "suit', and otherwise comply with all policy conditions.
d) The additional insured must tender the defense and indemnity of any claim or "suit' to any
provider of 'other insurance' which would cover the additional insured for a loss we cover under
this endorsement. However, this condition does not affect whether the insurance provided to the
additional insured by this endorsement is primary to 'other insurance" available to the additional
insured which covers that person or organization as a named insured as described in paragraph
3. above.
5. The following definition is added to SECTION V. -DEFINITIONS:
"Written contract requiring insurance" means that part of any written contract or agreement under
which you are required to include a person or organization as an additional insured on this
Coverage Part, provided that the 'bodily injury" and "property damage' occurs and the "personal
injury" is caused by an offense committed:
a. After the signing and execution of the contract or agreement by you;
b. While that part of the contract or agreement is in effect; and
c. Before the end of the policy period
Miscellaneous Attachment : M455192
Master ID: 1308383, Certificate ID: 3541032
POLICY NUMBER: VTC2JCAP5643B083TIL12 COMMERCIAL AUTO
EFFECTIVE DATES: 08/31/12 - 08/31/13
NAMED INSURED: MWH AMERICAS, INC; MWH CONSTRUCTORS, INC.; MWH GLOBAL, INC. ET AL
INSURANCE CARRIER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply
unless modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured
Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage
Form.
SCHEDULE
Name of Person(s) or Organization(s):
ANY PERSON OR ORAGNIZATION THAT YOU ARE _
REQUIRED TO INCLUDE AS ADDITIONAL
INSURED ON THIS COVERAGE FORM IN A
WRITTEN CONTRACT OR AGREEMENT THAT IS
SIGNED AND EXECUTED BY YOU BEFORE THE
"BODILY INJURY" OR "PROPERTY DAMAGE"
OCCURS AND THAT IS IN EFFECT DURING
THE POLICY PERIOD
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to the endorsement.)
Each person or organization shown in the Schedule is an "insured" for Liability
Coverage, but only to the extent that person or organization qualifies as an "insured"
under the Who Is An Insured Provision contained in Section II of the Coverage Form.
CA 20 48 02 99 Copyright, Ins. Services Office, Inc., 1998 Page 1 of 1
Miscellaneous Attachment : M455190
Master ID: 1308383, Certificate ID: 3541032
Named Insured: MWH Americas, Inc., MWH Constructors, Inc., MWH Global, Inc., MWH Soft, Inc. at. al.
Carrier: TRAVELERS INDEMNITY COMPANY Policy Number: VTC2KCO5643B1871ND12
EFFECTIVE DATES: 08/31/12 - 08/31/13
COMMERCIAL GENERAL LIABILITY
2. This insurance does not apply to damage to premises while
rented to you, or temporarily occupied by you with permission
of the owner, caused by:
a. Rupture, bursting, or operation of pressure relief devices:
b. Rupture or bursting due to expansion or swelling of the
contents of any building or structure, caused by or
resulting from water;
c. Explosion of steam boilers, steam pipes, steam engines,
or steam turbines.
temporarily occupied by you with
permission of the owner, caused by: fire;
explosion; lightning; smoke resulting from
such fire, explosion, or lightning; or water,
is not an "insured contract",
5. This Provision B. does not apply if coverage for Damage To
Premises Rented To You of COVERAGE A. BODILY INJURY
AND PROPERTY DAMAGE LIABILITY (Section I -
Coverages) is excluded by endorsement.
3. Paragraph 6. of LIMITS OF INSURANCE (Section Ill) is deleted
and replaced by the following: C. BLANKET WAIVER OF SUBROGATION
Subject to 5. above, the Damage To Premises Rented To You
Limit is the most we will pay under COVERAGE A. for the
sum of all damages because of "property damage" to any one
premises while rented to you, or temporarily occupied by you
with permission of the owner, caused by: fire; explosion;
lightning; smoke resulting from such fire, explosion, or
lightning; or water. The Damage To Premises Rented To You
Limit will apply to all "property damage" proximately caused
by the same "occurrence", whether such damage results
from: fire; explosion; lightning; smoke resulting from such fire,
explosion, or lightning; or water; or any combination of any of D.
these causes.
The Damage To Premises Rented To You Limit will be the
higher of:
a. $300,000; or
b. The amount shown on the Declarations for Damage To
Premises Rented To You Limit.
4. Paragraph a. of the definition of "insured contract"
(DEFINITIONS - Section V) is deleted and replaced by the
following:
a. A contract for a lease of premises. However, that portion of the
contract for a lease of premises that indemnities any person or
organization for damage to premises while rented to you, or
Page 2 of 6
CIS 03 16 07 04
Miscellaneous Attachment: M455193
Master ID: 1308383, Certificate ID: 3541032
We waive any right of recovery we may have against any person
or organization because of payments we make for injury or
damage arising out of: premises owned or occupied by or
rented or loaned to you; ongoing operations performed by you
or on your behalf, done under a contract with that person or
organization; "your work"; or "your products". We waive this
right where you have agreed to do so as part of a written
contract, executed by you before the "bodily injury" or
"property damage" occurs or the "personal injury" or
"advertising Injury" offense is committed.
BLANKET ADDITIONAL INSURED - MANAGERS OR LESSORS
OF PREMISES
WHO IS AN INSURED (Section II) is amended to include as an
insured any person or organization (referred to below as "additional
insured") with whom you have agreed in a written contract,
executed before the "bodily injury" or "property damage" occurs or
the "personal injury' or "advertising injury" offense is committed, to
name as an additional insured, but only with respect to liability
arising out of the ownership, maintenance or use of that part of any
premises leased to you, subject to the following provisions:
1. Limits of Insurance. The limits of insurance afforded to the
additional insured shall be the limits which you agreed to
provide in the written contract, or the limits shown on the
Declarations, whichever are less.
2. The insurance afforded to the additional insured does not apply
to:
.air►
TRAVELERS)
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 00 03 13 (00)- 01
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against the person or organization named in the Schedule. (This agreement applies only to the extent that
you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
DESIGNATED ORGANIZATION:
ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN
CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER.
INSURED: MWH GLOBAL, INC., MWH AMERICAS, INC., MWH CONSTRUCTORS, INC., ET AL
INSURANCE CO.: TRAVELERS
POLICY NO.: VTC2JUB50261-18112 (AOS)/ VTRJUB5643BO9512 (WI)
EFFECTIVE DATES: 08/31 /12 - 08/31 /13
Miscellaneous Attachment : M455194
Master ID: 1308383, Certificate ID: 3541032
POLICY NUMBER: VTC2JCAP5643B083TIL12
EFFECTIVE DATES: 08/31/12 - 08/31/13 COMMERCIAL AUTO
NAMED INSURED: MWH AMERICAS, INC; MWH CONSTRUCTORS, INC.; MWH GLOBAL, INC. ET AL
INSURANCE CARRIER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
This coverage applies only in the event of a total Recovery Against Others To Us is deleted and
theft of your covered "auto". replaced by the following:
No deductibles apply to Personal Effects
Coverage. 5. Transfer Of Rights Of Recovery Against
H. NOTICE OF AND KNOWLEDGE OF Others To Us
OCCURRENCE We waive any right of recovery we may
SECTION IV - BUSINESS AUTO have against any person or organization
CONDITIONS, A. 2. Duties In The Event Of to the extent required of you by a
Accident, Claim, Suit Or Loss, subparagraph written contract executed prior to any
a. is deleted and replaced by the following: "accident" or "loss", provided that the
a. In the event of "accident", claim, "suit" or "accident" or "loss" arises out of
"loss", you must give us or our authorized operations contemplated by such
representative prompt notice of the contract. The waiver applies only to the
"accident" or "loss" including: person or organization designated in
such contract.
(1) How, when and where the "accident" J.
or "loss" occurred;
(2) the "insured's" name and address; and
(3) to the extent possible, the names and
addresses of any injured persons and
witnesses.
Your duty to give us or our authorized
representative prompt notice of the
"accident" or "loss" applies only when the
"accident" or "loss" is known to:
1. You, if you are an individual;
2. A partner, if you are a partnership; or K.
3. An executive officer or insurance
manager, if you are a corporation.
BLANKET WAIVER OF SUBROGATION
SECTION IV - BUSINESS AUTO
CONDITIONS, A. Loss Conditions, 5.
Transfer Of Rights Of
CA T3 53 01 04
0da6f°,irs Attachment: M455191
Master ID: 1308383, Certificate ID: 3541032
UNINTENTIONAL ERRORS OR OMISSIONS
SECTION IV - BUSINESS AUTO
CONDITIONS, B. General Conditions; 2.
Concealment, Misrepresentation, Or Fraud is
amended by adding the following:
The unintentional omission of, or unintentional
error in, any information given by you shall not
prejudice your rights under this insurance.
How- ever this provision does not affect our
right to collect additional premium or exercise
our right of cancellation or non -renewal.
MENTAL ANGUISH
SECTION V - DEFINITIONS, Definition C. is
amended by adding the following:
"Bodily injury" also includes mental anguish but
only when the mental anguish arises from other
bodily injury, sickness, or disease.