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HomeMy WebLinkAbout504618 CONCRETE EXPRESS INC - INSURANCE CERTIFICATE (2)Client#: 51862 8CONCEXP ACOACORD.CERTIFICATE OF LIABILITY INSURANCE DATE 5/DDIYYYY) 101/2 101 /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 Tower 11, Suite 900 Denver, CO 80222 _ �i 0 ���(� CONTACT NAME: PHC, No xt: 303 722-7776 FA11 303.722-8862 O NEAIC, No E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE N1 Prope Property INSURER A: Travelers Property Casualty Corn 36161 INSURED Concrete Express, Inc. 2027 West Colfax Ave. INSURER B: St. Paul Fire and Marine Insura 24767 INSURER : Travelers Indemnity Company 25658 Denver, CO 80204 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 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 WVD POLICY NUMBER POLICY EFF MMIDD/YYri POLICY EXP ri (MM/DD/YY LIMITS A GENERAL LIABILITY VTC2JC05643B612TIL 5/01/2013 05/01/201A EACH OCCURRENCE $1 000,000 X COMMERCIAL GENERAL LIABILITY PREMISES E.u. ante s300,000 CLAIMS -MADE N OCCUR MED EXP (Any one person) $5 000 PERSONAL BADVINJURY $1,000,000 CGD24608/05 X GENERAL AGGREGATE 000,000 GEN'L AGGREGATELIMIT APPLIES PER: PRODUCTS-COMP/OP AGG OOQ OOOPOLICY XPRO LOG JECTA AUTOMOBILEUABILRY VTC2JCAP5643B624T1 5/01/2013 05/01/201 EOa BINEDISINGLELIMIT [s2, 00,000ANY BODILY INJURY (Per person) AUTO ALL OWNED SCHEDULED AUTOS BODILY INJURY(Per accident)AUTOS PROPERTY DAMAGE Per accident HIRED AUTOS X NON -OWNED AUTOS $ B X UMBRELLA LIAR OCCUR ZUP13N4919113NF 5/01/2013 05/01/2014 EACH OCCURRENCE $10000000 AGGREGATE $1 O 000 000 EXCESS UAB CLAIMS -MADE DED I X RETENTION $1 O 00O $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N OFFICEWMEMBER EXCLUDED? � N / A VTC2KUB4B88054013 5/01/2013 05/01/201A X TWRTATU- oTH- EL EACH ACCIDENT $1 00O 000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required) Project Description: MAX Project Project Number: WC#30521908-08-01 The following are Additional Insureds as respects General Liability and Umbrella Liability only if required by written contract and coverage applies only as respects work performed by the Insured for the Additional (See Attached Descriptions) City of Fort Collins Purchasing Division 215 N Mason St 2nd Floor PO 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 ACORD 25 (2010105) 1 of 2 #S1031624/M1030227 v TUUa-ZUTU AwttU GUKHUKA I IUN. All rights reserved. The ACORD name and logo are registered marks of ACORD 8TBEC DESCRIPTIONS (Continued from Page 1) Insureds. All coverage terms, conditions and exclusions of the policy apply. The following are Additional Insureds on the Automobile Liability only to the extent they meet the definition of an insured in the policy, which provides in pertinent part that an insured includes anyone liable for the conduct of an insured but only to the extent of that liability. All coverage terms, conditions and exclusions of the policy apply. Consult the policy to determine the extent of coverage, if any. Additional Insureds: City of Fort Collins, State of Colorado and Burlington Northern Santa Fe Railroad (BNSF). The General Liability, Auto Liabiity and Umbrella coverage is Primary per the policy terms & conditions only if required by written contract. The Workers' Compensation, Auto Liability, General Liability and Umbrella policies include a Waiver of Subrogation in favor of the Additional Insureds only if required by written contract. The Additional Insured endorsement which is referenced above under "Type of Insurance -General Liability' is attached. 5AU1I lA Z5.3 (ZU1U/U5) 2 of 2 #51031624/M1030227 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 Cover- age 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 in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance"_ This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications: and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work' and included in the "products -completed op- erations 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 oc- curs before the end of the period of time for which the "written contract requiring insur- ance" 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 additional insured by this endorsement still is ,excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 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 "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY L 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 de- fense 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 insur- ance provided to the additional insured by this endorsement is primary to 'other insur- ance" 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 in- sured on this Coverage Part, provided that the "bodily injury" and 'property damage" oc- curs 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. Page 2 of 2 © 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 00005]