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HomeMy WebLinkAbout168787 GOLDEN TRIANGLE CONSTRUCTION INC - INSURANCE CERTIFICATE (17)Client# 51g2D 8GOLDTRII ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE/Y1'YY) 101/02/202/2013 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 NAME: Willis of Colorado, Inc. 2000 South Colorado Boulevard Tower II, Suite 900 PHONE 303 722-7776 303-722-8862 o Ezt : ac, No ac, No, E-MAIL ADDRESS: INSURER(5) AFFORDING COVERAGE NAIC k Denver, CO 80222 alINSURERA: National Fire Ins. Company of H 2O478 INSURED Iv Golden Triangle Construction, Inc. 700 Weaver Park Road Longmont, CO 80501 INSURER B: National Union Fire Insurance o 19445 INSURER CPinnacol Assurance 41190 INSURER D: Continental Casualty Company 20443 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. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE r_X1 OCCUR X G 140331C 1Oil 0 2022866738 12/31/2012 12131/2013 EpDACHOECCURRENCE $1000000 PREMISES EeE000u nce $ 500 000 MED EXP (Any one person) s5,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO X I LOG JECT PRODUCTS - COMP/OP AGG $2,000,000 $ D AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED X HIRED AUTOS X AUTOS 2022866741 2/31/2012 12/31/201 EOao tlEDSINGLELIMIT $1,000,000 BODILY INJURY (Par person) $ BODILY INJURY (Per amident) $ PROPERTY DAMAGE Per accident $ E B X UMBRELLALIAS EXCESS LIAR OCCUR CIAIMS-MADE BE23465099 2/31/2012 12/31/2013 EACH OCCURRENCE s7000000 AGGREGATE s7,000,000 DED I X I RETENTION $10000 $ c WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEWE(ECUTIVE Y / N OFFICER/MEMBER EXCLUDED? F—Y] (Mandatory in NH) If yes, desrnbe under DESCRIPTION OF OPERATIONS below N/A 4013024 011110112012 01/01/201 X I WCSTATU- OTH- E.L. EACH ACCIDENT $1 00O 000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Project Description: 7426 Transfort Maintenance Facility Expansion, Fort Collins, Colorado The following are Additional Insureds as respects General Liability only if required by written contract and coverage applies only as respects (See Attached Descriptions) CI Of Fort Collins Purchasing SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Division ACCORDANCE WITH THE POLICY PROVISIONS. 215 North Mason Street, 2nd Floor AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 A- - An,, _ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1000436/M1000326 8AKRE DESCRIPTIONS (Continued from Page 1) work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. Additional Insureds: Owner, Engineer, Engineer's Consultants, respective officers and employees The Additional Insured endorsement which is referenced above under "Type of Insurance -General Liability" is attached. _ SAGITTA 25.3 (2010/05) 2 of 2 #S1000436/M1000326 Client8- 51920 8GOLDTRII ACORD,. CERTIFICATE OF LIABILITY INSURANCE D0 1 /0212013YY) 01/0212013 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 NAME: Willis of Colorado, Inc. ac°Ne, Ezt: 303 722-7776 FAX No : 303-722-8862 E-MAIL 2000 South Colorado Boulevard ADDRESS: Tower II, Suite 900 INSURER(S) AFFORDING COVERAGE NAIL p Denver, CO 80222 INSURER A: National Fire Ins. Company of H 26478 INSURED INSURER B: National Union Fire Insurance o 19445 Golden Triangle Construction of Pinnacol Assurance 41190 Southern Colorado Inc. INSURER C American Insurance Co 20621 4815 List Drive Suite 107 INSURER DOneBeacon Continental Casualty an INSURER E:� Company Y 20443 Colorado Springs, Co. 80919 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, INSR LTR TYPE OF INSURANCE ADDL INSR SUB MD POLICY NUMBER POLICY EFF MMIDDn'YYY POLICY EXP MMIDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR 2022866738 2/31/2012 12/31/2013 EACHOCCURRENCE$110001000 PR MISES Eao¢u once $500000 MED EXP (Any one person) $5 000 PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: RO LOC POLICY PRO- JECT PRODUCTS - COMPIOP AGG s2,000,000 $ E AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS X NON -OWNED AUTOS R 2022866741 12/31/2012 12/31/2013 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE$ Per accident E B X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE BE23465099 2/31/2012 12/31/2013 EACH OCCURRENCE s7,000,000 AGGREGATE s7,000,000 LED I X RETENTION $10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY P.ROPRIETORIPARTNERIEXECUTIVE Y I N OFFICERIMEMBER EXCLUDED? � (Mandatory in NH) If Yes, descrihe under DESCRIPTION OF OPERATIONS below NIA I I 4013024 I 1/01/2012 01W1/2013 X WCSTATIJ OTH- E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1 00O 000 POLICY LIMIT $1,000,000 D Lease/Rent Equip 790005057 2/31/2012 12/31/201 $100,000 Less Ded ACV Less Ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ft. Collins 215 N. Mason PO Box 580 Fort Collins, CO 80524 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 (2010/05) 1 of 1 #S1000603/M1000578 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SAKRE G140331C 1010 Page.1 of 2 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -WITH PRODUCTS -COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by "written contract' per Paragraph A. below.) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.) A. Section II - Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract' to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf in the performance of your ongoing operations specified in the "written contract"; or c. "Your work" that is specified in the "written contract" but only for "bodily injury" or "property damage" included in the "products -completed operations hazard," and only if: (1) The "written contract' requires you to provide the additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. We will not provide the additional insured any broader coverage or any higher limit of insurance than the least that is: a. Required by the "written contracf'; b. Described in 13.1. above; or c. Afforded to you under this policy. 3. This insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. But if required by the "written contract," this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. 4. The insurance provided to the additional insured does not apply to "bodily injury, "property damage," or "personal and advertising injury arising out of. a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying httn•//fnrmnet-ri rnn rnm1alhtm/rrAQ(177 htm 17/R/7011 G140331C 1010 Page 2 of 2 services, including: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities; or b. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part. C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result; (2) Except as provided in Paragraph B.3 of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part, (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit'; and (4) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this insurance to be primary and non-contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." 2. With respect only to the insurance provided by this endorsement, the first sentence of Paragraph 4.a. of the Other Insurance Condition is deleted and replaced with the following: 4. Other Insurance a. Primary Insurance This insurance is primary and non-contributory except when rendered excess by endorsement G- 140331-C, or when Paragraph b. below applies. D. Only for the purpose of the insurance provided by this endorsement, SECTION V — DEFINITIONS is amended to add the following definition: "Written contract" means a written contract or written. agreement that requires you to make a person or organization an additional insured on this Coverage Part, provided the contract or agreement: 1. Is currently in effect or becomes effective during the term of this policy; and 2. Was executed prior to: a. The "bodily injury" or "property damage" or b The offense that caused the "personal and advertising injury" for which the additional insured seeks coverage under this Coverage Part. Iittn'//fnT nPt_!a Pna Pnm/nlh4m /rnaOn77 btm 17/Q17l111