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HomeMy WebLinkAbout523225 POWERS THERMAL INSULATION - INSURANCE CERTIFICATEA� " CERTIFICATE OF LIABILITY INSURANCE °A�`/2013 "" 07126/2013 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 Marsh USA Inc. 333 South 71h Street, Suite 1600 CONTACT NAME: PHONE ac No EMAILADDRESS: Minneapolis, MN 55402-2400 Attn: minneapolis.cenrequestOmarsh.com 6 212.948.0114 INSURERS AFFORDING COVERAGE NAIC X INSURERA: New Hampshire Insurance Company 23841 025874-Stared GAWX-13 14 Powers INSURED United Subcontractors, Inc. INSURER B : Lexington Insurance Company 19437 tlba Powers Thermal Insulation INSURER C : INSURER D : 2645 Durango Drive Colorado Springs, CO 80910 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-004719948 01 REVISION NUMBER:I 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 LTA TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF fMWDDVYYYY POLICY EXP MIWDDMYY1 LIMITS A GENERAL LIABILITY GL 452 26 67 07I01)2013 07101/2014 EACH OCCURRENCE $ 2.000,000 X COMMERCIAL GENERAL LIABILITY DAMA T R NT D PREMISES fEoccurrence)$ 300,000 CLAIMS -MADE IJ OCCUR MED EXP (Any one person) $ 5,000 PERSONAL 6 ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000 $ POLICY X PRO LOG A AUTOMOBILE LIABILITY CA 327 5186 0710112013 07101/2014 ^OMB:NED SINGLE LIMIT Eaaccident) 2,000,11W BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident $ ALLOWNED SCHEDULED AUTOS AUTOS PPROPERTY DAMAGE uaccio far S HIRED AUTOS 1 11 SWNED B X UMBRELLA LIAB X OCCUR 006761832 0710112013 0710112014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,0M,J) EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$25.000 $ A WORKERS COMPENSATION WC 482 504 71 (ADS) 0710112013 0710112014 X I WC STATU OTH- I TOR LIMITS A A AND EMPLOYERS' LIABILITY ANY PROpmETOIVPARTNEWEXECUTrvE Y/ N OFFICER/MEMBER ExcwDliov ❑N (Mandatory in NH) N / A WC 482 504 72 INC, UT) WC 482 504 73 (NJ) 0710112013 0710112013 07/0112014 0710112014 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE EA EMPLOYE $ 1,000,000 E.L. DISEASE POLICY LIMIT 1,000,000 $ A If Yes describe under DESCRIPTION OF OPERATIONS below WC 482 504 74 (AZ, GA) 0710112013 07/0112014 A Workers Compensation WC 482 504 75 (CA) 07/01/2013 0710112044 SEE ABOVE A Workers Compensation WC 482 504 76 (FL) 0710112013 07101/2014 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more apace is required) Re: Project: Ft. Collins Senior Center, 7534 Rainlree Drive, FL Collins, Colorado. Certificate Holder and FL Collins Senior Center are included as additional insureds (except Workers' Compensation) where required by written contract. Waiver of subrogation is applicable where required by mitten contract. City of FL Collins 215 N. Mason St. Ft. 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 of Marsh USA Inc. Manashi Mukherjee Qp4�u 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CA 327 5186 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. - Endorsement Effective 07/01/2013 Countersigned By: Named Insured: UNITED SUBCONTRACTORS, INC. (Authorized Representative) SCHEDULE Name of Personfs) or Organi2ationls): WHERE REQUIRED BY WRITTEN CONTRACT Of no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to the endorsement.) Each person or organization shown in the Schedule is an 'insured" for Liability Coverage, but only to the ®extent that person or organization qualifies as an 'insured" under the Who Is An Insured Provision contained in Section 11 of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Ina.., 1998 Page 1 of 1 POLICYNUMBER: GL4522667 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 Persons) Or Or anization(s): Location(s) Of Covered Operations "ANY PERSON OR ORGANIZATION WHOM YOU "ALL JOBS/LOCATIONS" BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY WRITTEN CONTRACT OR AGREEMENT YOU HAVE ENTER INTO." Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the persons) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertis- ing injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional ex- clusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organiza- tion other than another contractor or sub- contractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: GL4522667 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization (s): Location And Description Of Completed Operations "ANY PERSON OR ORGANIZATION WHOM YOU "ALL JOBS/LOCATIONS" BECOME OBLIGAI ED TO INCLUDE AS AN ADDITONAL INSURED AS A RESULT OF ANY WRITTEN CONTRACT OR AGREEMENT YOU HAVE ENTERINTO" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and. in- cluded in the "products -completed operations hazard". CG 20 37 07 04 ® ISO Properties, Inc., 2004 Page 1 of 1 0 ENDORSEMENT This endorsement, afiectice 12:01 A,M. 07/01/2013 forms a pad of policYNO. CA3275186 issued to UNITED SUBCONTRACTORS. INC. by NEW HAMPSHIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following. BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights of Recovery Against Others to Us, is amended to add: However, we will waive any right of recover we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an "accident" or "loss" if: (T) The "accident" or "loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and (2) The contract or agreement was entered into prior to any "accident' or "loss". No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained by any injured employee. AeTHORi2ED , PPRESENTA' iVE. 62897 (6'951 POLICY NUMBER: GL 452 26 67. COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: PURSUANT TO APPLICABLE WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO. Information required to complete this Schedule, If not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or .'your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. C� 24 040509 C Insurance Services Office, -Inc:, 2008 - - Page 1 of 1 ❑ WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is Indicated below. (The roilorng etlactd-g clause" need be competed anly when this endGmarrant is issuea subsequent to preparation of Ir;s potipy). This endorsement, effective 12!01 AM 0710l/2013 Issued to UNITED SUBCONTRACTORS INC By NEW HAMPSH I RE INSURANCE COMPANY Premium forms a part of Policy No WC 482 504 71 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named In the Schedule. Schedule ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE ENTERED INTO A CONTRACT, A CONDITION OF WHICH REQUIRES YOU TO OBTAIN THIS WAIVER FROM US. THIS ENDORSEMENT DOES HOT APPLY TO BENEFITS OR DAMAGES PAID OR CLAIMED: 1. PURSUANT TO THE WORKERS' COMPENSATION OR EMPLOYERS' LIABILITY LAWS OF KENTUCKY, NEW HAMPSHIRE, OR NEW JERSEY; OR, 2. BECAUSE OF INJURY OCCURRING BEFORE YOU ENTERED INTO SUCH A CONTRACT. This form Is not applicable In California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Tennessee, Tetras, Utah, or Washirgton. WC 00 03 13 (Ed. 04184) Countersigned by Authorized Representative