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HomeMy WebLinkAbout168787 GOLDEN TRIANGLE CONSTRUCTION OF SOUTHERN C0 - INSURANCE CERTIFICATEClient#: 51920 BGOLDTRI I ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE /14/2013 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(es) 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 CONANTMEACT : Willis of Colorado, Inc. PHONE 303 722-7776 F'ix 303-722-8862 2000 South Colorado Boulevard E-MAIL Tower II, Suite 900 ADDRESS: Denver, CO 80222 t$ INSURE AFFORDING NAICp o Ins. yofHCOVERAGE INsuRERA: National Fire Ins. Company of H 20478 INSURED INSURER B: National Union Fire Insurance O 19445 Golden Triangle Construction of Assurance 41190 Southern Colorado, Inc. INSURER CPinnacol OneBeacon American Insurance Co 20621 4815 List Drive Suite 107 INSURER D: INSURERS: P Yon Continental Casualty Company 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 rypE OF INSURANCE ADDL INSR SUB MD POLICY NUMBER POLICY EFF MNUDD POLICY UP MMIDD LIMITS A _ GENERALLWBILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR 2022866738 2/31/2012 12/31/2012 EACH $1 000 000 �OCCURRENCE PREMISES Ea omu ante $ 500 000 MED UP (My one Person) s5,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PE ROT X LOC PRODUCTS - COMP/OP AGO $2,000,000 E E AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 2022866741 2/31/2012 12/31/2013 COMBINED SINGLE LIMIT Ea accident E 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY ( ) Peraccdent $i X PROPERTY DAMAGE P or. r accitleni $ E B UMBRELLALWB EXCESS UAB sf I OCCUR CLAIMS -MADE BE014722516 2/31/2012 12131/2013 FAcH OCCURRENCE s7,000,000 X ri AGGREGATE s7,000,000 DED X RETENTION$10, 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN N ANY PROPRIETOWPARTNEWEXECUTIVE�I yI OFFICERIMEMBER EXCLUDED? DJ Mandatory In NH)' If yes, deacnias under DESCRIPTION OF OPERATIONS below NIA 4013024 01/01/2013 01/01/2014 X WC STATU- OTH- TQRY_L E.L. EACH ACCIDENT E1 000,000 E.L. DISEASE - EA EMPLOYEE $1 000 000 E.L. DISEASE - POLICY LIMIT $1,000,000 D Lease/Rent Equip 7100332190000 2/31/2012 12131/2013 $100,000 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1005362/M1004078 SAKRE 13140331C 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 13.3 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 noncontributory, 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 contractor 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. httn•//fnr net_ci ena 1,t 11 Client#: 51920 8GOLDTRII ,�COR®TM CERTIFICATE OF LIABILITY INSURANCE DATE(MMYV) 13 1 /14/20113 r 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 iBELOW. 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. _ PHONE 303 722-7776 I FAX 303-722-8862 EA/ ,CAINo, Ezt): IA/C No): 2000 South Colorado Boulevard Tower II, Suite 900 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Denver, CO 80222 INSURERA: National Fire Ins. Company of H 2O478 INSURED INSURER B: National Union Fire Insurance o 19445 Golden Triangle Construction, Inc. Pinnacol Assurance 41190 700 Weaver Park Road INSURER C Continental Casualty Company INSURER D: Y P Y 20443 Longmont, CO 80501 INSURER E: INSURER F' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: r 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 ADDUSUBR INSR WVD POLICY NUMBER POLICY Err (MAID YYYYL POLICY EXP (MMIDDIYYYY)_ LIMITS A GENERALLIABILITY 2022866738 12/31/2012 12/31/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY _ CLAIMS -MADE 4OCCUR PREMISESCEaoN m�n�e —) $500000 MED EXP(Any one Pcrson) $5,000 PERSONAL&ADV INUURV $1,000,000 GEFFEN AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY X PRO- � LOC PRO- _ _ $ _ D AUTOMOBILE LIABILITY 2022866741 12/31/2012 12/31/201 3COMBINED SINGLE LIMIT lEa acodenl 1,DDD,ODD X BODILY INJURY (Per person) _$ $ ANY AUTO ALL OWNED SCHEDULEO AUTOS AUTOS BODILY INJURY (Par a,cadenl) $ X PROPERTY DAMAGE Per accident $ HIRED AUTOS X NON -OWNED AUTOS $ B UMBRELLA LIAR X OCCUR BE014722516 12/31/2012 12/31/2012 EACH OCCURRENCE $7 000,OOO X AGGREGATE s7,000,000 EXCESS UAB CLAIMS -MADE DED I X RETENTION$10,000 $ _ C WORKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY ANVETOR/PARTNER/EXECUTIVE OFFICERIMECFR/MEMBER EXCLUDED? Y N/A 4013024 1/01/2013 01/01/201 WCSTATU- OTH- X TORY LIMITS ER— _ EL EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE_ 51,000,000 (Mandatory in NH) [I;.._s dn.uibc undo. DESCRIPTION OF OPERATIONS tmloo, E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if 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 work performed by the Insured for the Additional Insureds. (See Attached Descriptions) City of Fort Collins Purchasing Division 215 North Mason Street, 2nd Floor Fort Collins, CO 80522 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 (2010105) 1 of 2 #S1005758/M1004051 91988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SAKRE DESCRIPTIONS (Continued from Page 1) M,;Il coverage terms, conditions and exclusions of the policy apply. Additional Insureds: Owner, Engineer, Engineer's Consultants, respective officers and employees I The Additional Insured endorsement which is referenced above under "Type it Insurance -General Liability" is attached. i 5AU11 IA 2b.3 (ZU1U/Ub) Z of 2 #S1005758/M1004051 Client#: 51920 8GOLDTRII ACORD,. CERTIFICATE OF LIABILITY INSURANCE o1114/2013ATE ) 1 /14l2013 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 Willis of Colorado, Inc. 2000 South Colorado Boulevard Tower 11, Suite 900 CONTACT NAME: PHONE AID, No, Et)303 722-7776 FAX,No 303-722-8862 ' AIC E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAICp Denver, CO 80222 INSURER A. National Fire Ins. Company of H 2O478 INSURED Golden Triangle Construction, Inc. 700 Weaver Park Road Longmont, CO 80501 INSURER B: National Union Fire Insurance o 19445 INSURER C Pinnacol Assurance 41190 INSURER DOneBeacon American Insurance Co 20621 Continental Casualty Company INSURER E: Y P Y 20443 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 ADDLSUEUR INSR MIT POLICY NUMBER POLICY EFF (MMIDDIYVYV) POLICY EXP (MMIDDIYYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ER OCCUR 2022866738 12/31/2012 12/31/2013 EACH OCCURRENCE $1,000,000 AMAGE T DORENTED PREMISES Ea occunence $500,000 MED EXP (Any one person) $5,000 PERSONAL B ADV NJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO X LOC POLICY X ECT PRODUCTS - COMP/OP AGO $2,000,000 $ E AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULEDBODILY AUTOSAUTOS HIRED AUTOB X NON -OWNED AUTOS IX 2022866741 12/31/2012 12/3112013 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY(Per person) $ INJURY (PeraccitlenQ $ PROPERTY DAMAGE Per accident $ B UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMSMADEAGGREGATE BE014722516 12/31/2012 12/3112013 EACH OCCURRENCE s7,000,000 X $7 000,000 DED I X I RETENTION $1 O 00O $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORPARTNERIEXECUTIVE�YIN OFRCERMEMBER EXCLUDED' (MandairryinNH) If yes, doscddc under DESCRIPTION OF OPERATIONS below IT NIA 4013024 1/01l2013 01/OV201 ,� rWCSTAMIT �OTH- �pRr_LIMITs�ee_ EL EACH ACC I DENT $1,000,000 -- E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 D LeaselRent Equip 7100332190000 12/31/2012 12/31/201 $100,000 less Ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H 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 (2010105) 1 of 1 #S1005664/M1004058 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 8AKRE Client#: 51920 8GOLDTRII ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 1/1412013 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. PHONE o 303 722-7776 F Alc NExt : AX AIC, a): 303-722-8862 2000 South Colorado Boulevard E-MAIL Tower II, Suite 900 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL# Denver, CO 80222 National Fire Ins. Company of H INSURER A: p y 2O478 INSURED INSURER B: National Union Fire Insurance o 19445 Golden Triangle Construction of INSURER CPinnacol Assurance 41190 Southern Colorado, Inc. INSURER D: Continental Casualty Company 20443 4815 List Drive Suite 107 Colorado Springs, CO 80919 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 ADDL INSR SUB MD POLICY NUMBER POLICY EFF (MMIDD/YYYY POLICY EXP (MM/DDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxIOCCUR X AI# G140331C 10/10 2022866738 2/31/201212/31/2013 EACH OECCURRENCE $1000GOO PR M 3ESEaEONNTVED nce $500 000 MEDEXP(Anyoneperson) s5000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X jRO X LOC PRODUCTS - COMPIOP AGG $2,000,000 $ D AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 2022866741 1213112012 12/31/201 EeaBINEDtSINGLELIMIT $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) E X PROPERTY DAMAGE Per accident $ b B UMBRELLA LIAR EXCESS LIAB J( OCCUR CLAIMS -MADE BE014722516 2/31/2012 12/31/2013 EACH OCCURRENCE s7.000.000 1t AGGREGATE s7,000,000 DED I X RETENTION $1 O 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? F7Y (Mandatory In NH) It yes. describe under DESCRIPTION OF OPERATIONS beknv NIA 4013024 1/01/2013 01/01/2014 X WC STATU- LP - .TORY_LIM R $1 GOO 000 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT 1 $1,000,000 T, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, If 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 work performed by the Insured for the Additional Insureds. (See Attached Descriptions) City of Fort Collins Purchasing Division 215 North Mason Street, 2nd Floor Fort Collins, CO 80522 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 (2010105) 1 of 2 #S1005456/M1004077 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BAKRE DESCRIPTIONS (Continued from Page 1) 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 (2010105) 2 of 2 #S1005456/M1004077 Cr140331C 1010 Page I of 2 Z' a" •� a ,. fin 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 operation's 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 contract"; b. Described in B.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 noncontributory 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 ltltnWfnrmnet-ri rna rnm/olhtm/rnnQ0')7 litm 11 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. httrr//fnrmnmt_n� rna rnm/nlhtm /rn aQM7 hfin H/O /'1n11 Client#: 51920 8GOLDTRI I ACORD.., CERTIFICATE OF LIABILITY INSURANCE D1114/2013ATE W) 1/14I2013 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. PHONE 303 722.7776 FAX 303.722-8862 AIC, No Ect :INC, No : 2000 South Colorado Boulevard E-MAIL Tower ll, Suite 900 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Denver, CO 80222 INSURER A: National Fire Ins. Company of H 2O478 INSURED INSURER B: National Union Fire Insurance O 19445 Golden Triangle Construction of INSURER CPinnacol Assurance 41190 Southern Colorado, Inc. INSURER D: OneBeacon American Insurance Co 20621 .. 4815 List Drive, Suite 107 INSURER E: Continental Casualty Company 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 ADDLSUBR INSR MD POLICY NUMBER POLICY Err (MMIDDMYY) POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY 2022866738 12/31/2012 12131/2013 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX_1 OCCUR PREMISESOEaEo RENTED s5000OO MED FXP (Any one person) $5 000 PERSONAL BADVINJURY $1,000,000 X G1403318 10/10 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO X LOC JECT_ _ _ $ E AUTOMOBILE LIABILITY 2022866741 12/31/2012 12/31/2013 COMBINED SINGLE LIMIT Ea accitlenl) $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident) $ HIRED AUTOS X NON -OWNED AUTOS $ B UMBRELLA LIAB X OCCUR BE014722516 2/31/2012 12131/2013 EACH OCCURRENCE $7000000 X AGGREGATE $7 00O 000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION$10,000 $ _ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVEIr`I'Nl OFFICER)MEMBER EXCLUDED? a N/A 4013024 0110112013 01/01/2014 X WC STATU- OTH- .TORYLIMI_T ER_ E.L. EACH ACCIDENT $1 OOO ODO E.L. DISEASE -EA EMPLOYEE $1 OOO OOO (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EL.DISEASE - POLICY LIMIT $1,000,000 D Blanket Builders 7100332190000 2/31/2012 12131/2013 $15,000,000 Limit Risk Ded: $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if 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 work performed by the Insured for the Additional Insureds. (See Attached Descriptions) City of Fort Collins Purchasing Division 215 North Mason Street, 2nd Floor Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORI ED REPRESENTATIVE ACORD 25 (2010105) 1 of 2 #S1005538/M1004076 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 8AKRE DESCRIPTIONS (Continued from Page 1) I 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 (2010105) 2 Of 2 #S1005538/M1004076 G140331C 1010 Page 1 of 2 i 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 contract" b. Described in B.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•//fnrmnef-ni nna Pnm/alhfm/PnnQf177 htm 17/R/7n11