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HomeMy WebLinkAboutWELHAM CONCRETE INC - INSURANCE CERTIFICATE (3)ACORa CERTIFICATE OF LIABILITY INSURANCE MOD YYI 3/7/2017/2014 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 Network Insurance Services,LLC 7395 E Orchard Rd -Ste A400 Greenwood Village CO 80111 O"T CT NAME: Brandie Tucker PNONE FAX D N° ` 303-708-0202 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE RAID MOUSER Afirst Mercury Insurance INSURED WELHA31 INSURER B:Colorado Casualty Co INSURER c:P0nnacoI Assurance of CO 41190 Welham Concrete, Inc. 13545 Thorncreek Circle Thornton CO 80241 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 1404067711 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. MISRla TYPE OF INSURANCE POLICY NUMBER MMNOY� PMNDY/YVYY LIMITS GENERAL LIABILITY x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR ACGLOGOOOIIOOB-01 222013 jnM014 EACH OCCURRENCE 111,000,000 $50,000 MED EXP (Any oneperson) f0 PERSONAL& ADV INJURY f1,000000 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE POLICY LIMB APPLIES PER: F7 PRO- ' LOC PRODUCTS-COMP/OP AGG f20000DO f AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOSAUTOS NONOWNEO HIRED AUTOS AUTOS BA0647897 5=013 /222014 Itlen 1000 000 BODILY INJURY(Perpelson) f BODILY INJURY(Per acaMent) f PROPERTY DAMAGE Few socken't)f f UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE f AGGREGATE f DEO RETENTION f WORKERS COMPENSATION A NDEMPLOYERSWBILITY YIN ANY PROPRIETORIPARTNERIEXECUMVE❑ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) Hysa, tleecrt0e antler DESCRIPTION OF OPERATIONS below NIA 4162597 12014 11112014 WCSiATU- E.L.EACH ACCIDENT $1.000,000 E.L. DISEASE - EA EMPLOYE f1,ODD,00D E.L. DISEASE -POLICY LIMIT 1 $1000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Aeach ACORD 101. Additional Remarks Schedule, N more apace Is required) City of Ft Collins is named as additional insured for General Liability. City of Fort Collins 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 R ESEEENNTTAATThirEE� �U/"J/LlJ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD P1NN/ICOL ASSURANCE Welham Concrete Inc 9004 Eldorado Ave Frederick, CO 80504 ENDORSEMENT: Blanket Waiver of Subrogation 7501 E Lowry Blvd Denver, CO 80230-7006 303-361 A000 / 800-873-7242 wvvw.pinnaeol.com NCCI #: WC000313B Policy #: 4162597 Network Insurance Services, LLC- POBox 910 Castle Rock, CO 80104 (303)708-9999 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 anyone not named in the Schedule. SCHEDULE To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. Effective Date: April 1, 2014 Expires on: April 1, 2015 Pinnacol Assurance has issued this endorsement March 7. 2014. Cora Gaines Underwriter 7501 E Lowry Blvd Denver, CO 80230-7006 Page 1 or 1 P GAINESC - Underwriter 03/07/2014 13:02:29 4162597 40813872 359-B POLICY NUMBER: MA-CGL-0000011008-01 COMMERCIAL GENERAL LIABILITY CG 32 28 0610 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COLORADO ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the follov ing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ izations Location And Description Of Completed Operations As Required By Written Contract $10,000 BI,PD,PI,AI, Per Claim DEDUCTIBLE, Including LAE applies Residential Comp Ops Information required to complete this Schedule Knot shavn above v ill 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 to the extent that the liability for "bodily injury' or "property damage' is caused by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard." CG 32 28 0610 © Insurance Service Office, Inc., 2010 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 32 27 06 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COLORADO ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies 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 for whom you are performing operations when you and such person or organization 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 by your ongoing operations for the additional insured and only to the extent that such "bodily injury", "property damage" or "personal and advertising injury' is caused by your acts or omissions or the acts or omissions of those performing operations on your behalf. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not a pply to: 1. "Bodily injury', "property damage" or "personal and advertising injury" arising out of the rendering of, or the 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. 2. "Bodily injury' or "property damage" occurring after a. All work including materials, parts or equipment 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 b. That portion of "your worle' out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 32 27 06 10 0 Insurance Services Office, Inc., 2010 Page 1 of 1 O