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HomeMy WebLinkAboutLEFT HAND EXCAVATING - INSURANCE CERTIFICATE (5)fAl 1i,1AII4:irT,W 8LEFTHANI ACORDTe CERTIFICATE OF LIABILITY INSURANCE DATEIYYYY) 1ln4/20anol2 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 Willis of Colorado, Inc. 2000 South Colorado Boulevard Tower II, Suite 900 CONTACT NAME: Pa"Co"N Ext: 303 722-7776 P, No: 303-722-8862 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Denver, CO 80222 INSURER A; Bituminous Casualty Corp. 20095 INSURED Left Hand Excavating 7733 N 73rd Street Longmont, CO 80503 INSURER B: National Union Fire Insurance O 19445 INSURER C: P tYecial an Atltic S Insurance 27154 INSURER DPinnacol Assurance 41190 INSURER E INSURER F : CnVFRAGES 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(MMIDDNYM POLICY EXP LIMITS A GENERALLIABIUITY CLP3579090 1/17/2012 11/1712013 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY PREMISETERENrDence $100 000 CLAIMS -MADE DJOCCUR MEDEXP(Any wererson) $10000 PERSONAL& ADV INJURY $1,000,000 GL30880911 X GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 $ POLICY X PROT LOG JEC A AUTOMOBILE LIABILITY CAP3579091 11/17/2012 11/17/2013 EOMBIINtlE�DSINGLELIMIT $1,000,000 BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED AUTOSAUTOS NON -OWNED HIRED AUTOS %t AUTOS IX PROPERTYDAMAGE Pera¢itlent $ $ B UMBRELLA LIAB X OCCUR BE037721853 11/171201211/17/2013 EACH OCCURRENCE $1000000 X AGGREGATE $1,000,000 EXCESS UNB CLAIMS -MADE DED I X I RETENTION $0 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIErOR/PARTNER/EXECUT VE Y I N OFPICERIMEMBER EXCLUDED? � (Mandatory In NH) NIA 1663960 0110112012 01/01/201 )( T RSTnru- OTH- E.L. EACH ACCIDENT ESOO OOO E.L. DISEASE- EA EMPLOYEE $500 000 E.L. DISEASE -POLICY LIMIT $500,000 If yes, describe under DESCRIPTION OF OPERATIONS hel. C Installation 7900067540004 1/17/2012 11/17/201 $250,000 Per Project Floater $50000TempStorageBTrans $1000 Ded DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Project Description: Right of Way Contractor's License The following are Additional Insureds as respects General Liability only to the extent coverage might apply according to the policy terms, conditions and exclusions. Consult the policy to determine extent of (See Attached Descriptions) City of Fort Collins P O Box 580 Fort Collins, CO 80522-0580 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 Mc 191111-9ntn ACORn Cf7RPORATIGN All rinhls rpsnrvnd ACORD 25 (2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD #S9894671M989438 8TBEC I. DESCRIPTIONS (Continued from Page 1) coverage. This Certificate confers no rights on the Certificate Holder. Additional Insureds: City of Fort Collins SAGITTA 25.3 (2010/05) 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LAND IMPROVEMENT CONTRACTORS EXTENDED LIABILITY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is agreed that the provisions listed below apply only upon the entry of an M in the box next to the caption of such provision. A. F)� ] Partnership and Joint Venture Extension B. Fr:] Contractors Automatic Additional Insured Coverage — Ongoing Operations C. Automatic Waiver of Subrogation D. Extended Notice of Cancellation, Nonrenewal E. Unintentional Failure to Disclose Hazards F. Broadened Mobile Equipment G. Personal and Advertising Injury - Contractual Coverage H. F�7 Nonemployment Discrimination I. Liquor Liability J. F� Broadened Conditions K. © Automatic Additional Insureds — Equipment Leases L F-71 Insured Contract Extension - Railroad Property and Construction Contracts M. © Construction Project General Aggregate Limits N. [57] Fellow Employee Coverage O. FF7] Property Damage to the Named Insured's Work P. 0 Care, Custody or Control Q. Electronic Data Liability Coverage R. © Consolidated Insurance Program Residual Liability Coverage S. © Automatic Additional Insureds — Managers or Lessors of Premises T. Automatic Additional Insureds — State or Governmental Agency or Political Subdivisions — Permits or Authorizations U. Contractors Automatic Additional Insured Coverage — Completed Operations V. © Additional Insured — Engineers, Architects or Surveyors A. PARTNERSHIP AND JOINT VENTURE EXTENSION The following provision is added to SECTION II - WHO IS AN INSURED: The last full paragraph which reads as follows: No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations is deleted and replaced with the following: With respect to the conduct of any past or present joint venture or partnership not shown as a Named Insured in the Declarations and of which you are or were a partner or member, you are an insured, but only with respect to liability arising out of "your work" on behalf of any partnership or joint venture not shown as a Named Insured in the Declarations, provided no other similar liability insurance is available to you for 'your work" in connection with your interest in such partnership or joint venture. GL-3088 (09/11) 1- 9. WHEN WE DO NOT RENEW a. If we choose to nonrenew this policy, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. b. If we do not give notice of our intent to nonrenew as prescribed in a. above, it is agreed that you may extend the period of this policy for a maximum additional sixty(60) days from its scheduled expiration date. Where not otherwise prohibited by law, the existing terms, conditions and rates will remain in effect during that extension period. It is further agreed that so long as it is not otherwise prohibited by law, this one time sixty day extension is the sole remedy and liquidated damages available to the insured as a result of our failure to give the notice as prescribed in 9. a. above. E. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Although we relied on your representations as to existing and past hazards, if unintentionally you should fail to disclose all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. F. BROADENED MOBILE EQUIPMENT Item 12.1b. of SECTION V - DEFINITIONS, is deleted and replaced with the following: 12.b. Vehicles maintained for use solely on or next to premises, sites or locations you own, rent or occupy. G. PERSONAL AND ADVERTISING INJURY -CONTRACTUAL COVERAGE Exclusion 2.e. of SECTION I, COVERAGE B is deleted. H. NONEMPLOYMENT DISCRIMINATION Unless "personal and advertising injury" is excluded from this policy: Item 14. of SECTION V - DEFINITIONS, is amended to include: 'Personal and advertising injury' also means embarrassment or humiliation, mental or emotional distress, physical illness, physical impairment, loss of earning capacity or monetary loss, wh_ich.is; caused by "discrimination." SECTION V - DEFINITIONS, is amended to include: "Discrimination" means the unlawful treatment of individuals based on race, color, ethnic origin, age, gender or religion. Item 2. Exclusions of SECTION I, COVERAGE B, is amended to include: "Personal and advertising injury" arising out of "discrimination" directly or indirectly related to the past employment, employment or prospective employment of any person or class of persons by any insured; 'Personal and advertising injury' arising out of "discrimination" by or at your, your agents or your "employees" direction or with your, your agents or your "employees" knowledge or consent, "Personal and advertising injury" arising out of "discrimination" directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any dwelling, permanent lodging or premises by or at the direction of any insured; or GL-3088 (09/11) -3- 3. "Property damage" to: a. Property owned, used or occupied by or rented to the additional insured; or b. Property in the care, custody or control of the additional insured or over which the additional insured is for any purpose exercising physical control. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. L. INSURED CONTRACT. EXTENSION - RAILROAD PROPERTY AND CONSTRUCTION CONTRACTS Item 9. of SECTION V - DEFINITIONS, is deleted and replaced with the following. 9. "Insured Contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement, d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement, f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the -tort liability..of another party,to,pay for 'bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage, or (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. GL-3088 (09/11) -5- N. FELLOW EMPLOYEE COVERAGE Exclusion 2.e. Employers Liability of SECTION I, COVERAGE A, is deleted and replaced with the following: 2.e. "Bodily injury" to (1) An "employee" of the insured arising out of and in the course of: (a) Employment by the insured; or (b) Performing duties related to the conduct of the insured's business, or (2) The spouse, child, parent, brother or sister of that "employee" as a consequence of paragraph (1) above. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other capacity; and (2) To any obligation to share damages with or repay someone else who must pay damages because of the injury. This exclusion does not apply to: (1) Liability assumed by the insured under an "insured contract'; or (2) Liability arising from any action or omission of a co -"employee" while that co -"employee" is either in the course of his or her employment or performing duties related to the conduct of your business. Item 2.a. (1)(a) of SECTION II - WHO IS AN INSURED, is deleted and replaced with the following: 2.a. (1)(a) To you, to your partners or members (if you are a partnership or joint venture) or to your members (if you are a limited liability company), or to your "volunteer workers" while performing duties related to the conduct of your business. O. PROPERTY DAMAGE TO THE NAMED INSURED'S WORK Exclusion I of SECTION I, COVERAGE A. is deleted and replaced with the following: I. Damage to Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products completed operation hazard." This exclusion applies only to that portion of any loss in excess of $50,000 per occurrence if the damaged work and the work out of which the damage arises was performed by you. This exclusion does not apply if the damaged work or the work out of which the damage adses was performed on your behalf by a subcontractor. GL-3088 (09/11) -7 Id. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it: or C. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate "electronic data", resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, "electronic data" is not tangible property. R. CONSOLIDATED INSURANCE PROGRAM RESIDUAL LIABILITY COVERAGE With respect to "bodily injury', "property damage', or 'personal and advertising injury" arising out of your ongoing operations, or operations included within the "products -completed operations hazard", the policy to which this coverage is attached shall apply as excess insurance over coverage available to "you" under a Consolidated Insurance Program (such as an Owner. Controlled Insurance Program or Contractors Controlled Insurance Program). Coverage afforded by this endorsement does not apply to any Consolidated Insurance Program involving a "residential project" or any deductible or insured retention, specified in the Consolidated Insurance Program. The following is added to Section V — Definitions "Residential project" means any project where 30% or more of the total square foot area of the structures on the project is used or is intended to be used for human residency. This includes but is not limited to single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit developments and appurtenant structures (including pools, hot tubs, detached garages, guest houses or any similar structures). A "residential project" does not include military owned housing, college/university owned housing or dormitories, long term care facilities, hotels, motels, hospitals or prisons. All other terms, provisions, exclusions and limitations of this policy apply. S. AUTOMATIC ADDITIONAL INSUREDS -MANAGERS OR LESSORS OR PREMISES SECTION II —WHO IS AN INSURED is amended to include: Any person or organization with whom you agree in a written contract or written agreement to name as an additional insured but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises, designated in the written contract or written agreement, that is leased to you and subject to the following additional exclusions: 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, new construction or demolition operations performed by or on behalf of the additional insured listed in the written contract or written agreement. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be noncontributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. GL-3088 (09111) -9- With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to 'bodily injury', 'property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications, or 2. Supervisory, inspection or engineering services This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But, with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. GL-3088 (09/11) -11-