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HomeMy WebLinkAboutUSA CONSTRUCTION INC - INSURANCE CERTIFICATE (2)Client#: 56403 SUSACONSI ACORD,. CERTIFICATE OF LIABILITY INSURANCE D3/01/2013ATE Y) 3/01 /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 Willis of Colorado, Inc. 2000 South Colorado Boulevard CONTACT Jeri Frickey PAIHONECo 720-974-2715 FAX. 720-524-0130 NEat : AIC. No E-MAIL eri.fricke //��willis.com ADDRESS: I yV Tower Il, Suite 900 INSURER(S) AFFORDING COVERAGE NAIL# Denver, CO 80222 INSURER A: Employers Mutual Casualty 21415 INSURED U.S.A. Construction, Inc P.O. Box 325 INSURER B : Plnnacol Assurance 41190 INSURER C Timnath, CO 80547 INSURER D 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 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 LTR TYPE OF INSURANCE ADDLSUB INSR VIVO POLICY NUMBER POLICY EFF (MM/DD POLICY UP MM/DD LIMBS A GENERALLIABIUT' 4X87600-14 2/01/2013 0210112014 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY PREMISES EaEoiwE� nce $10O 000 CLAIMS -MADE 51OCCUR MED UP (Any we person) $1 O 000 PERSONAL &ADV INJURY $1,000,000 #CG7174.3(01/08) X GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 $ POLICY X PRO- LOD A AUTOMOBILE LIABILITY 4X87600-14 2/01/2013 02101/2014 EaCOMBINED tSINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X HIRED AUTOS X NON -OWNED AUTOS A X UMBRELLALIAB X OCCUR 4X87600-14 2/01/2013 02/01/2014 EACH OCCURRENCE $1 000000 AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILT ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? NIA 4027969 4/01/2012 04101/2013 X T RSTAMU- OTH- E.L. EACH ACCIDENT $1 OOOD00 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, desoibe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Add ltlonal Remarks Schedule, if mom space is required) The following are Additional Insureds as respects General Liability only if required by written contract and coverage applies only as respects ongoing operations performed by the Insured for the Additional Insureds. (See Attached Descriptions) City of Fort Collins P.O. Box 580 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 DIRT. 11t�s�ml ACORD 25 (2010105) 1 of 2 #S1016652/M1016626 ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 8TBEC DESCRIPTIONS (Continued from Page 1) Additional Insureds: City of Fort Collins All coverage terms, conditions and exclusions of the policy apply. The Additional Insured endorsement which is referenced above under "Type of Insurance -General Liability" is attached. SAGITTA 25.3 (2010/05) 2 of 2 #51016652/M1016626 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - CONSTRUCTION CONTRACTS INCLUDING COMPLETED OPERATIONS This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization when you have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such 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: 1. Your acts or omissions; 2. The acts or omissions of those acting on your behalf; in the performance of: a. your ongoing operations for the additional insured; or b. "Your work" for the additional insured and included in the "products — completed operations hazard". B. 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" and "personal and advertising injury" arising out of the rendering of, or failure to render, any professional, architectural, engineering or surveying services including: a. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. C. The limits of insurance applicable to the additional insured are those specified in the Declarations of this policy or in the written contract or written agreement, whichever is lower. D. Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether that insurance is primary, excess, contingent or on any other basis, unless you and the additional insured have specifically agreed in a written contract or written agreement that this insurance be primary. When coverage is provided on a primary basis we will not seek contribution from any other insurance available to the additional insured if a written contract or written agreement requires that this insurance be noncontributory. E. All other terms and conditions of this policy remain unchanged. CG7174.3(1-08) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 1 of 1