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HomeMy WebLinkAbout287763 TRAUTMAN & SHREVE INC - INSURANCE CERTIFICATE (2)AT CERTIFICATE OF LIABILITY INSURANCE I D091E8/20113 DIYYYY) 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: N 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. 501 MERRITT 7 NORWALK, CT 06856 Attn: Emoor.Cerhequest@marsh.cem I Fax 203-229-6787 INSURED TRAUTMAN 8 SHREVE, INC. 4406 RACE STREET DENVER, CO 80216 Continental Casualty Transportation Insurance Of Reading, Pa COVERAGES CERTIFICATE NUMBER: NYC-M73%5.31 REVISION NUMBER:2 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 L TYPE OF INSURANCE A PoLICY NUMBER M POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR GL 4025755083 10/0112013 10101/2014 EACH OCCURRENCE B 2,000,000 DAMAGE PREMISES nen 3 1,000,000 MED EXP (My oneperson) S 25,000 PERSONAL & ADV INJURY i 2,000,000 GENERAL AGGREGATE S 6,000.000 GENL AGGREGATE POLICY LIMIT APPLIES PER: X I PRO. LOC PRODUCTS - COMPIOP AGG S 14,00D,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS X NON -OWNED HIRE[ AUTOS N AUTOS OUA4025755133 1010112013 10101I2014 EOMBodentlSINGLELMR b 200p qg0 BODILY INJURY (Per Person) $ BODILY INJURY (Per accident) a PROPERTY DAMAGE Per actident) $ Auto Physical Damage B Included A X UMBRELLA LIAR EXCESS LIAB X OCCUR CWMS4AADE L 2068208285 1MI12013 1010112014 EACH OCCURRENCE $ 5.000A00 AGGREGATE $ 5.000,000 DIED X RETENTION$ 10,000 & B 6 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTRVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory In NH) ny deso" unmr DESCRIPTION OF OPERATIONS below N / A WC 4025755021(AOS) WC 4025755035 CA ( ) WC 4025755018 AZ, WI OR ( ) 4101013 10101f2013 10/01I2013 1=1/2014 I0fMR014 10p12014 X nRSTATII DTH- EL EACH ACCIDENT 1,000,000 s EL DISEASE -EA EMPLOYE S 1,OOQ000 E.L. DISEASE -POLICY LIMB 1,000,000 I s DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) Re'. all operations. Additional insureds under all policies (except Workers' Comp.) where required by contract. City of fort Collins. City of Fort Collins 300 Laporte Avenue 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 of Marsh USA Inc. Heidi Bauermeister - 10 ,4"4K-J LeZ�P/ Cr01989-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 888715 LOC #: Norwalk ACORbP ADDITIONAL REMARKS SCHEDULE AGENCY (NAMED INSURED MARSH USA, INC. TRAUTMAN & SHREVE, INC. 4406 RACE STREET POLICY NUMBER DENVER, CO 80216 CARRIER I NAIC CODE EFFECTIVE DATE: ki Rely-laf 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Auto Physical Damage Comp I Coll Deductible $500 Page 2 of 2 In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Pad (other than the reduction of aggregate limits through paymenl of claims as applicable), Insurer agrees to mail pnorwritten notice of cancellation or material change to: Certificate Holder Schedule 1. Number of days advance notice: For any statutorily permitted reason other than num-payment of premium, the number of days required for notice of cancellation as provided in paragraph 2 of either the Cancellation Common Policy Conditions or as amended by the applicable state cancellation endorsement is increased to the lesser of 60 days or the number of days required in a written contract. For non-payment of premium, The greater of (1) the number of days required by state law or (2) the number of days required by written contract 2. Name: Notice will be mailed to: Certificate holder ACORD 101 (2008101) V LUVO MI..V RU VVRrVRM I1V n. MII 19sIZ ICDCI VCV. The ACORD name and logo are registered marks of ACORD A�RD® CERTIFICATE OF LIABILITY INSURANCE OATS 09118120132013 YYYY, 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. 501 MERRITT 7 NORWALK, CT 06856 Attu: Emcor.Cedrequest@marsh.com l Fax. 203-229 6787 CONTACT NAME: A/CNoFAV E-MAIL AODR _ INSURERS AFFORDING COVERAGE NAIC S INSURER A: Continental Casualty Company 20443 888715-EMC-TRA13-14 ABCDE 21318 X INSURED TRAUTMAN & SHREVE, INC. 4406 RACE STREET INSURER 0, American Casualty Company Of Reading, Pa 20427 INSURER C : Transportation Insurance Co 20494 INSURER 0: DENVER, CO 80216 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: NYC-OD6620083-06 REVISION NUMBER:3 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. VIER TR TYPE OF !INSURANCEPOLICY ADDLISURIA NUMBER POLICY EFF PWLOIOY LIMITS A GENERAL LIABUTY GL 4025755083 1010112013 1010112014 EACH OCCURRENCE s 2,000,D00 DAMAGE PREMISES n S 1.000,000 X COMMERCIAL GENERAL LIABILITY MED EXP (Anone neon $ 25,000 CLAIMS -MADE � OCCUR PERSONAL& ADV INJURY $ 2,0D0.000 GENERAL AGGREGATE $ 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 14,000,000 $ PoUCY X I'.LOG A AUTOMOBILE LIABILITY BUA 4025755133 1010112013 1010112014 COMBINED IN LE LIMIT (Ea accident) s 2000000 BODILY INJURY (Per penon) & X ANY AUTO BODILY INJURY (Per sodldMH) $ ALL OWNED SCHEDULED AUTOS AUTOS X INON-OWNED X HIRED AUTOS AUTOS PROPERTY DAMAGE P raccident) & Auto Physical Damage $ Included A X UMBRELLA DAB X CCCUR L 206B208285 10/01/2013 10101/2014 EACH OCCURRENCE E 5,000,000 EXCESS LIA9 CLAIMS -MADE AGGREGATE If5'�'� DED X RETENTIONS10,000 It B WORKERS COMPENSATION WC 4025755021 A05 10101/2013 10/01/2014 X I WCSTAru- OTH- B C AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICEWMEMBER EXCLUDED?Ifl (Mondatory In NH) H yaa. desonoe under DESCRIPTION OF OPERATIONS below N/A WC 4025755035 (CA) WC 4025755016 AZ, WI OR) ( 10101/2013 10/01/2013 1010112014 1010112014 1,000,000 $ - E 1,000,000 1,000,000 s E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYE E.L. DISEASE- POLICY LIMIT DESCPoPf1°N OF OPERATIONS/ LOCATIONS / VEHICLES (AWc i ACORD 101, AUd flonN Remarks SChOduM. H Mora apace b ra fkArad) RE. JOB NO. 21318-101 - POUDRE VALLEY HEALTH SYSTEM BUILDING A DEMO ADDITIONAL INSURED UNDER ALL POLICIES (EXCEPT WORKERS COMPENSATION & EMPLOYERS LIABILITY) WHERE REQUIRED BY CONTRACT: THE INDEMNITEES COVERAGE PROVIDED TO THE ADDITIONAL INSUREDS IS PRIMARY & NON-CONTRIBUTORY. WAIVER OF SUBROGATION AS REQUIRED BY CONTRACT. CONTRACTUAL LIABILITY COVERAGE IS INCLUDED. UMBRELLA POLICY SITS ABOVE THE UNDERLYING GENERAL LIABILITY, EMPLOYERS' LIABILITY AND AUTO LIABILITY. THE GENERAL LIABILITY POLICY HAS NO XCU EXCLUSION. CITY OF FORT COLLINS 300 LAPORTE AVE. FORT COLLINS, CO 80521 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. Heidi Bauenneister „�//Bcyic ,�21C'iJ/�rIL P� 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 888715 LOC s: Norwalk ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY I NAMEDMSURED MARSH USA, INC. TRAUTMAN & SHREVE, INC. 4406 RACE STREET POLICY NUMBER DENVER, CO 80216 CARRIER I NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Auto Physical Damage Comp I Coll Deductible E500 In the event of cancellation or material charge that reduces a restricts the insurance afforded by this Coverage Pan (other than the reduction of aggregate limits through payment of daims as applicable), Insurer agrees to mail prior when notice of cancellation or material charge to: Certificate Holder Schedule 1. Number of days advance notice: For any statutorily per milled reason other man flompayment of premium, the number a( days required for notice d cancellation as provided in paragraph 2 of either the Cancellation Common Policy CDridNDt6 or as amended by the applicable stale cancellation endorsement is increased to the lesser of 60 days or the number of days required in a written contract. For non-payment of premium, The greater of (1) the number of days required by state law of (2) the number of days required by written contract. 2. Name: Notice wlll be mailed to: Certificate holder Arnon ton r�nnamt t © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL4026755083 Carrier: Continental Casualty Co Effective date: 104 -13 to 104 -14 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 PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: INSURED: TRAUTMAN & SHREVE, INC. CERTIFICATE HOLDER: CITY OF FORT COLLINS RE: JOB NO. 21318-107 - POUDRE VALLEY HEALTH SYSTEM BUILDING A DEMO THE INDEMNITEES Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph S. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recoverywe may have againstthe person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"yourwork" 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. CG 24 04 05 09 Copyright, Insurance Services Office, Inc, 2008 Page 1 of 1 POLICY NUMBER: BUA 4025755133 COMMERCIAL AUTO CARRIER: Continental Casualty Co CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided underthe following BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respectto coverage provided bythis endorsement, the provisions of the Coverage Form apply unless modified byth[ endorsement.. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured EMCOR Group, Inc. Endorsement Effective Daohtic 10-1-13to10-1-14 SCHEDULE Name(s) Of Person(s) Or Organization(s): INSURED: TRAUTMAN & SHREVE, INC. CERTIFICATE HOLDER: CITY OF FORT COLLINS RE: JOB NO. 21318-107 - POUDRE VALLEY HEALTH SYSTEM BUILDING A DEMO THE INDEMNITEES Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The TransferOf Rights Of RecoveryAgainst OthersTo Us Condition does not applyto the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogationis waived priorto the "accident' orthe "loss" undera contractwith that person or organization. CG04440310 Copyright, Insurance Services Office, Inc., 2009 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC000313 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 Indirectlyto benefit anyone not named in the Schedule. Schedule Any Person or Organization forwhom the Named Insured has agreed by written contractto furnish this waiver. (This endorsement is not applicable in the states of California, Kentucky, New Hampshire, New Jersey, Missouri, Texas, and Utah.) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/0112013- 10/01/2014 Policy Na: WC 4025755021 Insurance Company. American Casualty Co. of Reading, PA. Countersigned by WC 00 03 13 Copyright 1983 National Council on Compensation Insurance. (Ed. 4-64) POLICY NUMBER OL 4025755083 Carrier. Continental Casually Co Formerly Known as CO 2010 1 VW Effective date: 10MV2013-10/OV2014 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS FORM B) THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON OR ORGANIZATION: INSURED: TRAUTMAN & SHREVE, INC. CERTIFICATE HOLDER: CITY OF FORT COLLINS RE: JOB NO. 21318-107 - POUDRE VALLEY HEALTH SYSTEM BUILDING A DEMO THE INDEMNITEES (If no entry appears above, information required to complete this endorsementwill be shown in the Declarations as applicable to this endorsement.)❑ WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but onlywith respectto liability arising out of"yourwork" forthat insured by orforyou. Countersigned by Authorized Representative POLICY NUMBER: BUA4025755133 CARRIER: Continental Casualty Co Business Auto Policy Effective daft 10/01,2013.10t012014 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Blanket Additional Insured — As Required By Contract This endorsement modifies Insurance provided under the rollowing. Business Auto Coverage Form Schedule Name of person or organization. Any person or organization torwhom you are obligated to provide Business Auto Liability Insurance coverage as an additional insured bycontract or agreement. Paragraph 1. Who is An Insured (Section II — Liability Coverage) is amended to include as an Insured the person or organization show in the schedule, but only with respect to tiabillty arising out of the ownership, maintenance or use of a covered auto. Our limit of liability for the additional insured will not exceed the limits of liability of this policy. The inclusion of more than one insured In this policy will not operate to increase our limit of liability. Copyngtt, Insurance Services Omce, Inc., 1992