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HomeMy WebLinkAbout124948 TOP GUN PRESSURE WASHING INC - INSURANCE CERTIFICATE (13)SL ACOR" CERTIFICATE OF LIABILITY INSURANCE 6/28/2013 DATEYYYV) 13 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 endorsements . PRODUCER CONTACT NAME: PHONE FAX Aic. No X`' i,303-867-2055ac NP: - 7-2 74 Olson & Olson Ltd 5655 S. Yosemite St. #101 Greenwood Village CO 80111 E-MAIL ADDREss,o2 Is n I n. m INSURERS AFFORDING COVERAGE NAIC # '' 11 INSURER A:PinnacolA f n INSURED TOPGU-1 INSURER B:AmeriC@n Select Insurance Com 9992 INSURER C: Top Gun Pressure Washing, Inc. INSURER D: 500 W. 67th Avenue Loveland CO 80538 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1265846399 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 rypE OF ADDL INSR UBR MD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDII'YYY LIMITS B GENERAL LIABILITY x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [K ] OCCUR Y Y TRA6418137 7/1/2013 /112014 EACH OCCURRENCE $1,000,000 DAMAGE TO RFNTFD PREMISES Ea occunence $100 000 MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PER. X PRO- LOG PRODUCTS-COMPIOP AGG $2,000,000 $ B LIABILITY NYAUTOBODILY LLOWNEDSCHEDULED UTOSAUTOS NON-OED AUTOS WTJH AUTOS Y TRA6418137 7/1/2013 /1/2014COMBINED SINGLE LIMIT Ea accident $1000000 INJURY(Per person) $ RMOBILE BODILY INJURY(Per accident) $ PROPERTY DAMAGEIRED Per accident $ $ B X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE TRA6418137 /1/2013 /1/2014 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 DEO X RETENTION$0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F-1 (Mandatory in NH) If yecrib s. dese under DE SCRIPTION OF OPERATIONS belor NIA y 4031609 7/1/2013 /1/2014 X WC STATU- OTH- TORY LIMITS E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1.000.000 EL DISEASE -POLICY LIMIT $1,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Contract Work. The City, its officers, agents and employees are included as Additional Insured as required by written contract as respects General Liability per form CG3229 06/10 attached and Automobile Liability per form CA7078 09/11 attached. General Liability & Workers' Compensation includes Waiver of Subrogation in favor of The City, its officers, agents and employees as required by written contract. sllli l.IaC1 City of Fort Collins Purchasing Department; Attn: John Stevens 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 ACORD 25 (2010105) ©1 The ACORD name and logo are registered marks of ACORD All riahts reserved. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXPANDED ENDORSEMENT This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM SCHEDULE The coverage provided by this endorsement is summarized below and is intended to provide a general coverage description only. For the details affecting each coverage, please refer to the terms and condi- tions in this endorsement. A. Who Is An Insured broadened: • Additional Insured by Contract, Agreement or Permit • Legally Incorporated Subsidiaries • Newly Acquired Organizations B. Supplementary Payments • Bail Bonds - $5000 • Loss of Earnings - $500 C. Fellow Employee Exclusion Amendment D. Coverage Extensions • Transportation Expenses • Personal Effects (Excess Basis) E. Additional Coverages • Expenses paid for returning a stolen covered auto • Fire Department Service Charge F. Airbag Coverage - Accidental Discharge G. Glass Repair - Waiver of Deductible H. Knowledge and Notice of an Accident, Claim or Suit I. Unintentional Failure To Disclose Hazards J. Worldwide Coverage K. Definitions • Bodily Injury Redefined In addition to the policy amendments contained in A. through K. listed above, the endorsements listed below will automatically be attached to your policy to complete the coverage provided by the Business Auto Expanded Endorsement: • Audio. Visual and Data Electronic Equipment Coverage Added Limits - CA 99 60 • Auto Loan/Lease Gap Coverage - CA 20 71 • Drive Other Car Coverage - Broadened Coverage For Named Individuals - (Executive Officers/Spouses) - CA 99 10 • Employee Hired Autos - CA 20 54 • Employees As Insureds - CA 99 33 • Hired Auto Physical Damage (Refer to Auto Declarations page) • Rental Reimbursement Coverage - CA 99 23 • Waiver of Transfer of Rights of Recovery (Waiver of Subrogation) - CA 04 44 A. WHO IS AN INSURED BROADENED SECTION II - LIABILITY COVERAGE, item A. Coverage, 1. Who Is An Insured is amended to include the following additional para- graphs: Any legally incorporated subsidiary of yours in which you own more than 50% of the voting stock on the ef- fective date of this endorsement. However. "insured" does not include any subsidiary that is an "insured" under any other liability policy or would be an "insured" under such a policy but for its termination or the exhaustion of its limit of insurance. Coverage under this provision is af- forded only for the first 180 days af- ter you acquire or form the organization or until the end of the policy period, whichever comes first. e. Any organization you newly acquire or form. other than a partnership or joint venture, and maintain ownership terest. However. this provision: over which you or a majority in - coverage under CA 70 78 09 11 Page 1 of 3 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COLORADO ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations) Location(s) Of Covered Operations All persons or organizations when you have agreed in writing in a contract or agreement that such persons or organizations be added as an additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Who Is An Insured (Section II) is amended to This insurance does not apply to "bodily in - include as an additional insured the person(s) jury" or "property damage" occurring after: or organization(s) shown in the Schedule, but "bodily 1. All work, including materials, parts or only with respect to liability for injury", equipment furnished in connection with property damage" or "personal and adver- such work, on the project (other than tising injury" caused by your ongoing oper- service, maintenance or repairs) to be ations for the additional insured(s) at the performed by or on behalf of the addi- location(s) designated above and only to the tional insured(s) at the location of the extent that such "bodily injury", "property covered operations has been completed, damage" or "personal and advertising injury" or is caused by your acts or omissions or the acts or omissions of those performing oper- 2• That portion of "your work" out of which ations on your behalf. the injury or damage arises has been put to its intended use by any person or or- B. With respect to the insurance afforded to ganization other than another contractor these additional insureds, the following addi- or subcontractor engaged in performing tional exclusion applies: operations for a principal as a part of the same project. ® Insurance Services Office, Inc., 2010 CG 32 29 05 10