Loading...
HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8192 ELECTRICAL SERVICES 2015 (4)ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC JECT PRODUCTS - COMP/OP AGG OTHER: $ COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD FORM NUMBER: EFFECTIVE DATE: The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE FORM TITLE: Page of THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01) AGENCY CUSTOMER ID: LOC #: AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE © 2008 ACORD CORPORATION. All rights reserved. CCIG GREIELE-01 SEE PAGE 1 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance 1 SEE P 1 Greiner Electric LLC; Greiner Electric of Wyoming, LLC 12456 N. Dumont Way Littleton, CO 80125 SEE PAGE 1 DENESEB 1 Additional Coverages Installation Floater Carrier: Travelers Property & Casualty Policy #: QT6309006X291TIL19 Effective Dates: 10/1/19 - 10/1/20 Limit: $500,0000 Deductible: $1,000 Crime Carrier: Travelers Casualty & Surety Policy #:106600065 Effective Dates: 10/1/18 - 10/1/21 Limit: $2,000,000 Deductible: $5,000 Professional/Pollution Carrier: St. Paul Surplus Lines Insurance Company Policy #: 16N64338 Effective Dates: 10/1/19 - 10/1/20 Limit Per Claim: $1,000,000 / Limit Per Aggregate: $2,000,000 Retention: $25,000 Stop Gap Liability - WY Carrier: Charter Oak Fire Insurance Co. Policy #: CO9N997650COF19 Effective Dates: 10/1/19 - 10/1/20 Limits: $1M Each Accident/ $1M Disease Policy Limit/ $1M Disease Each Employee 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 c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for "bodily injury", requiring insurance" specifically requires you "additionalproperty damage" or "personal injury"; and to provide such coverage for that insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "specificallywritten contract requiring insurance", the in- "written contract requiring insurance" suranceprimary provided to the additional insured requires that this insurance apply on a shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III Limits Of Insurance. for such loss, and we will not share with that "other insurance". But the insurance provided to b) The insurance provided to the additional in- the additional insured by this endorsement still is sured does not apply to "bodily injury", "prop- excess over any valid and collectible "other in- erty damage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- i. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving,written or failing to prepare or ap- a) The additional insured must give us prove, drawings and specifications; and notice as soon as practicable of an "occur- rence" or an offense which may result in a ii. Supervisory, inspection, architectural or claim. To the extent possible, such notice engineering activities. should include: CG D2 46 08 05 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 Policy Number: CO9N997650COF19 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" any provider of "other insurance" which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses; and condition does not affect whether the insur- ance provided to the additional insured by iii. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the "occurrence" or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or "suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: 5. The following definition is added to SECTION V. i. Immediately record the specifics of the DEFINITIONS: claim or "suit" and the date received; and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or "suit" as person or organization as an additional in- soon as practicable. sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or "suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect; and fense and indemnity of any claim or "suit" to c. Before the end of the policy period. Page 2 of 2 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Aircraft Chartered With Pilot H. Blanket Additional Insured Lessors Of Leased B. Damage To Premises Rented To You Equipment C.Political Increased Supplementary Payments I. Blanket Additional Insured States Or Subdivisions Permits D. Incidental Medical Malpractice J. Knowledge And Notice Of Occurrence Or Offense E. Who Is An Insured Newly Acquired Or Formed Organizations K. Unintentional Omission F.Subrogation Who Is An Insured Broadened Named Insured L. Blanket Waiver Of Unnamed Subsidiaries M. Amended Bodily Injury Definition G. Blanket Additional Insured Owners, Managers N. Contractual Liability Railroads Or Lessors Of Premises PROVISIONS INJURY AND PROPERTY DAMAGE LI- ABILITY:A. AIRCRAFT CHARTERED WITH PILOT The following is added to Exclusion g., Aircraft, Exclusions c. and g. through n. do not apply Auto Or Watercraft, in Paragraph 2. of SECTION to "premises damage". Exclusion f.(1)(a) I COVERAGES COVERAGE A BODILY IN- does not apply to "premises damage" caused JURY AND PROPERTY DAMAGE LIABILITY: by: This exclusion does not apply to an aircraft that a. Fire; is: b. Explosion; (a) Chartered with a pilot to any insured; c. Lightning; (b) Not owned by any insured; and d. Smoke resulting from such fire, explosion, (c) Not being used to carry any person or prop- or lightning; or erty for a charge. e. Water; B. DAMAGE TO PREMISES RENTED TO YOU unless Exclusion f. of Section I Coverage A 1.Liability The first paragraph of the exceptions in Ex- Bodily Injury And Property Damage clusion j., Damage To Property, in Para- is replaced by another endorsement to this graph 2. of SECTION I COVERAGES Coverage Part that has Exclusion All Pollu- COVERAGE A BODILY INJURY AND tion Injury Or Damage or Total Pollution Ex- PROPERTY DAMAGE LIABILITY is deleted. clusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION I "premises damage" as described in Para- COVERAGES COVERAGE A. BODILY graph 6. of SECTION III LIMITS OF IN- SURANCE. CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 Policy Number: CO9N997650COF19 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- C. INCREASED SUPPLEMENTARY PAYMENTS TION III LIMITS OF INSURANCE: 1. The following replaces Paragraph 1.b. of Subject to 5. above, the Damage To Prem- SUPPLEMENTARY PAYMENTS COVER- ises Rented To You Limit is the most we will AGES A AND B of SECTION I COVER- pay under Coverage A for damages because AGE: of "premises damage" to any one premises. b. Up to $2,500 for the cost of bail bonds The Damage To Premises Rented To You required because of accidents or traffic Limit will apply to all "property damage" law violations arising out of the use of any proximately caused by the same "occur- vehicle to which the Bodily Injury Liability rence", whether such damage results from: Coverage applies. We do not have to fur- f ifrom re; explosion; lightning; smoke resulting nish these bonds. such fire, explosion, or lightning; or water; or 2. The following replaces Paragraph 1.d. of any combination of any of these causes. SUPPLEMENTARY PAYMENTS COVER- The Damage To Premises Rented To You AGES A AND B of SECTION I COVER- Limit will be: AGES: a. The amount shown for the Damage To d. All reasonable expenses incurred by the Premises Rented To You Limit on the insured at our request to assist us in the Declarations of this Coverage Part; or investigation or defense of the claim or b. $300,000 if no amount is shown for the "suit", including actual loss of earnings up Damagefrom To Premises Rented To You to $500 a day because of time off Limit on the Declarations of this Coverage work. Part. D. INCIDENTAL MEDICAL MALPRACTICE 4. The following replaces Paragraph a. of the 1. The following is added to the definition of "oc- definition of "insured contract" in the DEFINI- currence" in the DEFINITIONS Section: TIONS Section: "Occurrence" also means an act or omission a. A contract for a lease of premises. How- committed in providing or failing to provide ever, that portion of the contract for a "incidental medical services", first aid or lease of premises that indemnifies any "Good Samaritan services" to a person. person or organization for "premises 2. The following is added to Paragraph 2.a.(1) of damage" is not an "insured contract"; SECTION II WHO IS AN INSURED: 5. The following is added to the DEFINITIONS Section: Paragraph (1)(d) above does not apply to "bodily injury" arising out of providing or fail- "Premises damage" means "property dam- ing to provide: age" to: (i) "Incidental medical services" by any of a. Any premises while rented to you or tem- your "employees" who is a nurse practi- porarily occupied by you with permission tioner, registered nurse, licensed practical of the owner; or nurse, nurse assistant, emergency medi- b. The contents of any premises while such cal technician or paramedic; or premises is rented to you, if you rent such (ii) First aid or "Good Samaritan services" by premises for a period of seven or fewer any of your "employees" or "volunteer consecutive days. workers", other than an employed or vol- 6. The following replaces Paragraph 4.b.(1)(b) unteer doctor. Any such "employees" or of SECTION IV COMMERCIAL GENERAL " v olunteer workers" providing or failing to LIABILITY CONDITIONS: provide first aid or "Good Samaritan ser- (b) That is insurance for "premises damage"; vices" during their work hours for you will or be deemed to be acting within the scope 7. Paragraph 4.b.(1)(c) of SECTION IV of their employment by you or performing COMMERCIAL GENERAL LIABILITY CON- duties related to the conduct of your busi- DITIONS is deleted. ness. Page 2 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 5. of 4. Any organization you newly acquire or form, SECTION III LIMITS OF INSURANCE: other than a partnership, joint venture or lim- ited For the purposes of determining the applica- liability company, of which you are the ble Each Occurrence Limit, all related acts or sole owner or in which you maintain the ma- omissions committed in providing or failing to jority ownership interest, will qualify as a provide "incidental medical services", first aid Named Insured if there is no other insurance or "Good Samaritan services" to any one per- which provides similar coverage to that or- son will be deemed to be one "occurrence". ganization. However: 4. The following exclusion is added to Para- a. Coverage under this provision is afforded graph 2., Exclusions, of SECTION I COV- only: ERAGES COVERAGE A BODILY INJURY (1) Until the 180th day after you acquire or AND PROPERTY DAMAGE LIABILITY: form the organization or the end of the Sale Of Pharmaceuticals policy period, whichever is earlier, if you "writingBodily injury" or "property damage" arising do not report such organization in out of the willful violation of a penal statute or to us within 180 days after you acquire or ordinance relating to the sale of pharmaceuti- form it; or cals committed by, or with the knowledge or (2) Until the end of the policy period, when consent of, the insured. that date is later than 180 days after you 5. The following is added to the DEFINITIONS acquire or form such organization, if you Section: report such organization in writing to us "formIncidental medical services" means: within 180 days after you acquire or a. Medical, surgical, dental, laboratory, x-ray it, and we agree in writing that it will con- or nursing service or treatment, advice or tinue to be a Named Insured until the end instruction, or the related furnishing of of the policy period; food or beverages; or b. Coverage A does not apply to "bodily injury" b. The furnishing or dispensing of drugs or or "property damage" that occurred before medical, dental, or surgical supplies or you acquired or formed the organization; and appliances. c. Coverage B does not apply to "personal in- jury" "Good Samaritan services" means any emer- or "advertising injury" arising out of an gency medical services for which no compen- offense committed before you acquired or sation is demanded or received. formed the organization. 6. The following is added to Paragraph 4.b., Ex- F. WHO IS AN INSURED BROADENED NAMED cess Insurance, of SECTION IV COM- INSURED UNNAMED SUBSIDIARIES MERCIAL GENERAL LIABILITY CONDI- The TIONS: following is added to SECTION II WHO IS AN INSURED: The insurance is excess over any valid and collectible other insurance available to the in- Any of your subsidiaries, other than a partnership, sured, whether primary, excess, contingent or joint venture or limited liability company, that is on any other basis, that is available to any of not shown as a Named Insured in the Declara- your "employees" or "volunteer workers" for tions is a Named Insured if you maintain an own- "bodily injury" that arises out of providing or ership interest of more than 50% in such subsidi- failing to provide "incidental medical ser- ary on the first day of the policy period. vices", first aid or "Good Samaritan services" No such subsidiary is an insured for "bodily injury" to any person to the extent not subject to or "property damage" that occurred, or "personal Paragraph 2.a.(1) of Section II Who Is An injury" or "advertising injury" caused by an of- Insured. fense committed after the date, if any, during the E. WHO IS AN INSURED NEWLY ACQUIRED policy period, that you no longer maintain an OR FORMED ORGANIZATIONS ownership interest of more than 50% in such sub- sidiary. The following replaces Paragraph 4. of SECTION II WHO IS AN INSURED: CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED OWNERS, H. BLANKET ADDITIONAL INSURED LESSORS MANAGERS OR LESSORS OF PREMISES OF LEASED EQUIPMENT The following is added to SECTION II WHO IS The following is added to SECTION II WHO IS AN INSURED: AN INSURED: Any person or organization that is a premises Any person or organization that is an equipment owner, manager or lessor and that you have lessor and that you have agreed in a written con- agreed in a written contract or agreement to in- tract or agreement to include as an insured on clude as an additional insured on this Coverage this Coverage Part is an insured, but only with re- Part is an insured, but only with respect to liability spect to liability for "bodily injury", "property dam- for "bodily injury", "property damage", "personal age", "personal injury" or "advertising injury" that: injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that a. Is "bodily injury" or "property damage" that occurs,advertising or is "personal injury" or "advertising occurs, or is "personal injury" or " injury" caused by an offense that is commit- injury" caused by an offense that is commit- ted, subsequent to the execution of that con- ted, subsequent to the execution of that con- tract or agreement; and tract or agreement; and b. Arises out of the ownership, maintenance or b. Is caused, in whole or in part, by your acts or use of that part of any premises leased to omissions in the maintenance, operation or you. use of equipment leased to you by such equipment lessor. The insurance provided to such premises owner, The insurance provided to such equipment lessor manager or lessor is subject to the following pro- is subject to the following provisions: visions: a. The limits of insurance provided to such a. The limits of insurance provided to such equipment lessor will be the minimum limits premises owner, manager or lessor will be which you agreed to provide in the written the minimum limits which you agreed to pro- contract or agreement, or the limits shown on vide in the written contract or agreement, or the Declarations, whichever are less. the limits shown on the Declarations, which- b. ever are less. The insurance provided to such equipment lessor does not apply to any "bodily injury" or b. The insurance provided to such premises "property damage" that occurs, or "personal owner, manager or lessor does not apply to: injury" or "advertising injury" caused by an of- (1) Any "bodily injury" or "property damage" fense that is committed, after the equipment that occurs, or "personal injury" or "adver- lease expires. tising injury" caused by an offense that is c. The insurance provided to such equipment committed, after you cease to be a tenant lessor is excess over any valid and collectible in that premises; or other insurance available to such equipment (2) Structural alterations, new construction or lessor, whether primary, excess, contingent demolition operations performed by or on or on any other basis, unless you have behalf of such premises owner, lessor or agreed in the written contract or agreement manager. that this insurance must be primary to, or c. The insurance provided to such premises non-contributory with, such other insurance, owner, manager or lessor is excess over any in which case this insurance will be primary valid and collectible other insurance available to, and non-contributory with, such other in- to such premises owner, manager or lessor, surance. whether primary, excess, contingent or on I. BLANKET ADDITIONAL INSURED STATES any other basis, unless you have agreed in OR POLITICAL SUBDIVISIONS PERMITS the written contract or agreement that this in- The surance must be primary to, or non- following is added to SECTION II WHO IS contributory with, such other insurance, in AN INSURED: which case this insurance will be primary to, Any state or political subdivision that has issued a and non-contributory with, such other insur- permit in connection with operations performed by ance. you or on your behalf and that you are required Page 4 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY byliability any ordinance, law or building code to include (ii) A manager of any limited as an additional insured on this Coverage Part is company; or an insured, but only with respect to liability for (iii) An executive officer or director of "bodily injury", "property damage", "personal in- any other organization; jury" or "advertising injury" arising out of such op- that is your partner, joint venture erations. member or manager; or The insurance provided to such state or political (b) Any "employee" authorized by such subdivision does not apply to: partnership, joint venture, limited li- ability a.organization Any "bodily injury," "property damage," "per- company or other sonal injury" or "advertising injury" arising out to give notice of an "occurrence" or of operations performed for that state or po- offense. litical subdivision; or (3) Notice to us of such "occurrence" or of an b. Any "bodily injury" or "property damage" in- offense will be deemed to be given as cluded in the "products-completed operations soon as practicable if it is given in good hazard". faith as soon as practicable to your work- ers' J. KNOWLEDGE AND NOTICE OF OCCUR- compensation insurer. This applies RENCE OR OFFENSE only if you subsequently give notice to us The following is added to Paragraph 2., Duties In of the "occurrence" or offense as soon as The Event of Occurrence, Offense, Claim or practicable after any of the persons de- Suit, of SECTION IV COMMERCIAL GEN- scribed in Paragraphs e. (1) or (2) above ERALoffense LIABILITY CONDITIONS: discovers that the "occurrence" or may result in sums to which the insurance e. The following provisions apply to Paragraph provided under this Coverage Part may a. above, but only for the purposes of the in- apply. surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. However, if this Coverage Part includes an en- of Section II Who Is An Insured: dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution (1) Notice to us of such "occurrence" or of- costs arising out of a discharge, release or es- fense must be given as soon as practica- cape of "pollutants" which contains a requirement ble only after the "occurrence" or offense that the discharge, release or escape of "pollut- is known by you (if you are an individual), ants" must be reported to us within a specific any of your partners or members who is number of days after its abrupt commencement, an individual (if you are a partnership or this Paragraph e. does not affect that require- joint venture), any of your managers who ment. is an individual (if you are a limited liability K. UNINTENTIONAL OMISSION company), any of your "executive offi- The cers" or directors (if you are an organiza- following is added to Paragraph 6., Repre- tion other than a partnership, joint venture sentations, of SECTION IV COMMERCIAL or limited liability company) or any "em- GENERAL LIABILITY CONDITIONS: ployee" authorized by you to give notice The unintentional omission of, or unintentional of an "occurrence" or o f fense. error in, any information provided by you which (2) If you are a partnership, joint venture or we relied upon in issuing this policy will not preju- limited liability company, and none of your dice your rights under this insurance. However, partners, joint venture members or man- this provision does not affect our right to collect agersof are individuals, notice to us of such additional premium or to exercise our rights "occurrence" or offense must be given as cancellation or nonrenewal in accordance with soon as practicable only after the "occur- applicable insurance laws or regulations. rence" or offense is known by: L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph 8., Transfer (i) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership or joint venture; of SECTION IV COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- 3. "Bodily injury" means bodily injury, mental ment to waive that insured's right of recovery anguish, mental injury, shock, fright, disability, against any person or organization, we waive our humiliation, sickness or disease sustained by right of recovery against such person or organiza- a person, including death resulting from any tion, but only for payments we make because of: of these at any time. a. "Bodily injury" or "property damage" that oc- N. CONTRACTUAL LIABILITY RAILROADS curs; or 1. The following replaces Paragraph c. of the b. "Personal injury" or "advertising injury" definition of "insured contract" in the DEFINI- caused by an offense that is committed; TIONS Section: subsequent to the execution of that contract or c. Any easement or license agreement; agreement. 2. Paragraph f.(1) of the definition of "insured M. AMENDED BODILY INJURY DEFINITION contract" in the DEFINITIONS Section is de- leted. The following replaces the definition of "bodily injury" in the DEFINITIONS Section: Page 6 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: ISSUE DATE: 10-01-19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, GENERAL AGGREGATE IN A WRITTEN CONTRACT WHICH IS IN EFFECT LIMIT SHOWN ON THE DURING THIS POLICY PERIOD, TO PROVIDE A DECLARATIONS. SEPARATE GENERAL AGGREGATE LIMIT; PROVIDED THAT, THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A. obligated to pay as damages caused by "occur- for damages or under COVERAGE C. for rences" under COVERAGE A. (SECTION I), and medical expenses shall reduce the Desig- for all medical expenses caused by accidents un- nated Project General Aggregate Limit for der COVERAGE C (SECTION I), which can be that designated "project". Such payments attributed only to operations at a single desig- shall not reduce the General Aggregate Limit nated "project" shown in the Schedule above: shown in the Declarations nor shall they re- 1. A separate Designated Project General Ag- gregate Limit applies to each designated "pro- ject", and that limit is equal to the amount of duce any other Designated Project General Aggregate Limit for any other designated "project" shown in the Schedule above. the General Aggregate Limit shown in the 4. The limits shown in the Declarations for Each Declarations, unless separate Designated Occurrence, Damage To Premises Rented Project General Aggregate(s) are sched- To You and Medical Expense continue to uled above. apply. However, instead of being subject to 2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A., except damages because of "bodily injury" or "prop- the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Ag- gregate Limit. erty damage" included in the "products- B. For all sums which the insured becomes legally completed operations hazard", and for medi- obligated to pay as damages caused by "occur- cal expenses under COVERAGE C, regard- rences" under COVERAGE A. (SECTION I), and less of the number of: for all medical expenses caused by accidents un- a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". der COVERAGE C. (SECTION I), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: CG D2 11 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 CO9N997650COF19 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. vided, any payments for damages because of for damages or under COVERAGE C. for "bodily injury" or "property damage" included in medical expenses shall reduce the amount the "products-completed operations hazard" will available under the General Aggregate Limit reduce the Products-Completed Operations Ag- or the Products-Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gregate Limit, whichever is applicable; and gate Limit nor the Designated Project General 2. Such payments shall not reduce any Desig- Aggregate Limit. nated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- C. Part 2. of SECTION III LIMITS OF INSURANCE is deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Damages under Coverage B; and tions Section is amended by the addition of the following definition: "Project" means an area away from premises owned by or rented to you at which you are per- forming operations pursuant to a contract or agreement. For the purposes of determining the b. Damages from "occurrences" under applicable aggregate limit of insurance, each COVERAGE A (SECTION I) and for all "project" that includes premises involving the medical expenses caused by accidents same or connecting lots, or premises whose con- under COVERAGE C (SECTION I) which nection is interrupted only by a street, roadway, cannot be attributed only to operations at waterway or right-of-way of a railroad shall be a single designated "project" shown in the SCHEDULE above. considered a single "project". F. The provisions of SECTION III LIMITS OF D. When coverage for liability arising out of the INSURANCE not otherwise modified by this en- "products-completed operations hazard" is pro- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: ISSUE DATE: 10/01/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL AGGREGATE LIMIT OTHER THAN PROJECTS AND DESIGNATED PROJECT AND LOCATION AGGREGATE LIMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE – LIMITS OF INSURANCE AND DESIGNATED PROJECTS AND LOCATIONS LIMITS OF INSURANCE Total Aggregate Limit $ 12,000,000 (Other Than Projects and Products-Completed Operations) Designated Location Aggregate Limit $ 2,000,000 (Other Than Products-Completed Operations) Designated Project Aggregate Limit $ 2, 000,000 (Other Than Products-Completed Operations) General Aggregate Limit $ 2,000,000 (Other Than Products-Completed Operations) Designated Projects: Each “project” for which you have agreed in a written contract that is in effect during this policy period, to provide a separate General Aggregate Limit, provided that the contract is signed by you before the “bodily injury” or “property damage” occurs. Designated Locations: 12466 - 12456 N. DUMONT WAY LITTLETON, CO 80125 2 2 418 SE 8TH STREET OFFICE SUITE B4 LOVELAND, CO 80537 3 3 1110 ELKTON DRIVE OFFICE UNIT B COLORADO SPRINGS, CO 80907 4 4 12432 N DUMONT WAY OFFICE LITTLETON, CO 80125 5 5 525 ELK AVENUE OFFICE UNIT# 3-1 JACKSON, WY 83001 6 6 8135 BRANDON DRIVE YARD WITH FENCE LITTLETON, CO 80125 PROVISIONS 1. The General Aggregate Limit (Other Than Products-Completed Operations) shown in the Declarations is replaced by the Limits of Insurance shown in the Schedule – Limits Of Insurance And Designated Projects And Locations. 2. The following replaces Paragraph 1. of SECTION III – LIMITS OF INSURANCE: 1. The Limits of Insurance shown in the Declarations or the Schedule – Limits Of Insurance And Designated Projects And Locations, whichever apply, and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought; CG D4 69 02 19 © 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. CO9N997650COF19 COMMERCIAL GENERAL LIABILITY c. Persons or organizations making claims or bringing "suits"; or d. "Projects" or "locations". 3. The following replaces Paragraph 2. of SECTION III – LIMITS OF INSURANCE: 2. a. The Total Aggregate Limit shown in the Schedule – Limits Of Insurance And Designated Projects And Locations is the most we will pay for the sum of all amounts under the Designated Location Aggregate Limit and all amounts under the General Aggregate Limit. This includes: (1) Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; (2) Damages under Coverage B; and (3) Medical expenses under Coverage C. b. The Designated Project Aggregate Limit shown in the Schedule – Limits Of Insurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The Designated Project Aggregate Limit is the most we will pay for the sum of: (a) Damages under Coverage A because of "bodily injury" and "property damage" caused by "occurrences"; and (b) Medical expenses under Coverage C for "bodily injury" caused by accidents; that can be attributed only to operations at a single "project". (2) The Designated Project Aggregate Limit applies separately to each "project". (3) The Designated Project Aggregate Limit does not apply to damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard". Instead, the Products-Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (4) The Designated Project Aggregate Limit does not apply to damages under Coverage B. Instead, the General Aggregate Limit described in Paragraph 2.d. below applies to such damages. (5) Any payments made for damages or medical expenses to which the Designated Project Aggregate Limit applies will reduce the Designated Paragraph 2.d. below applies to such damages. (5) Any payments made for damages or medical expenses to which the Designated Location Aggregate Limit applies will reduce: (a) The Total Aggregate Limit; and (b) The Designated Location Aggregate Limit for the applicable "location". Such payments will not reduce the General Aggregate Limit described in Paragraph 2.d. below, the Designated Project Aggregate Limit or the Designated Location Aggregate Limit for any other "location". d. Subject to the Total Aggregate Limit described in Paragraph 2.a. above, the General Aggregate Limit shown in the Schedule – Limits Of Insurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The General Aggregate Limit is the most we will pay for the sum of: (a) Damages under Coverage A because of "bodily injury" and "property damage" caused by "occurrences", and medical expenses under Coverage C for "bodily injury" caused by accidents, that cannot be attributed only to operations at a single "project" or a single "location"; and (b) Damages under Coverage B. (2) The General Aggregate Limit does not apply to damages for "bodily injury" or "property damage" included in the "products-completed oper- ations hazard". Instead, the Products-Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (3) Any payments made for damages or medical expenses to which the COMMERCIAL GENERAL LIABILITY General Aggregate Limit applies will reduce: (a) The Total Aggregate Limit; and (b) The General Aggregate Limit. Such payments will not reduce the Designated Project Aggregate Limit for any "project" or the Designated Location Aggregate Limit for any "location". 4. The following replaces Paragraph 3. of SECTION III – LIMITS OF INSURANCE: COMM E RCI A L AUTO T H IS ENDORSEMENT CHANGES T H E POLICY. PL E ASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE Thi s e n dorseme n t m o d i fie s i n surance provded i under t he f o l l o w ing: BUS I NE S S A U TO C OV E RAGE F O RM PROVISIONS 2. The fol l o w ing i s added to Paragraph B . 5. , O t he r 1. The fo l lowing is added to Paragraph A.1.c., Who In s u r ance of SE C TION IV BUSIN E SS AUT O Is An Insu r ed , of SE C TION Il COV E RED COND I T I ON S: AU T OS LIAB I LIT Y CO V E R AGE : Re g ardle s s o f the provsions i o f pa r ag r aph a. a n d Thi s i n cludes any pe r son or organization who yo u pa r ag r aph d. of this part 5. O t her Insurance, this are requi r ed under a writ t en co n tra c t o r i n suran c e i s prim a ry to and non-contri b utory wit h ag r ee m ent betwee n yo u and that perso n o r appl i cable othe r in s urance under which an organi z a t ion, that is signed by you be f o r e the addi t ional insured person o r o r ganiza t io n is the "bodi l y inju r y " or "property dam a ge " o c curs and fi r st nam e d insured when the writ t en co n tra c t o r that i snam i n e f fe c t during the poli c y period, to e ag r ee m ent be t ween you and that person o r a s an addit i onal i n sured fo r Cov e red Auto s organi z ation, that is signed by you be f o r e the Lia b il i ty Cov e rage, but only fo r dam a ges to whi c h "bo d ily inj u ry " or "property dam a ge " o c curs and th i s insuran c e applie s and only to the ex t ent o f that i s in e f fe c t duri n g the pol i cy period, requi r e s that person ' s or o r ganiza t io n 's l i abi l i t y fo r the th i s i n surance to be prim a ry an d non-contri b utory. conduct o f anothe r "in s ured". CA T 4 74 0 2 16 © 2016 The T r avelers Indemnit y Company. All righ ts reserved. Pa g e 1 of 1 Includes copyrighted material of IOf nsurance Services f i ce, Inc. with its permis s ion. Policy Number: 8109N921108TIL19 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE LOSS OF B.LIMIT BLANKET ADDITIONAL INSURED USE INCREASED C. EMPLOYEE HIRED AUTO I. PHYSICAL DAMAGE TRANSPORTATION EXPENSES INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO LIMITED WORLDWIDE COV- LOSS ERAGE INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is person or organization qualifies as an "insured" An Insured, of SECTION II COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section II. Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" everperforming is earlier. name, with your permission, while duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who Is An Insured, of SECTION II COVERED Other Insurance, of SECTION IV BUSI- NESS AUTOS LIABILITY COVERAGE: AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered "autos" you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow; and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy Number: 8109N921108TIL19 COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions However, any "auto" that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered "auto". (i) You must arrange to defend the "in- sured" D. EMPLOYEES AS INSURED against, and investigate or set- tle any such claim or "suit" and keep The following is added to Paragraph A.1., Who Is us advised of all proceedings and ac- An Insured, of SECTION II COVERED AUTOS tions. LIABILITY COVERAGE: (ii) Neither you nor any other involved Any "employee" of yours is an "insured" while us- "insured" will make any settlement ing a covered "auto" you don't own, hire or borrow without our consent. in your business or your personal affairs. (iii) We may, at our discretion, participate E. SUPPLEMENTARY PAYMENTS INCREASED in defending the "insured" against, or LIMITS in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II COVERED AUTOS LIABIL- (iv) We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of of SECTION II COVERED AUTOS LIABIL- SECTION II COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. (for4) All reasonable expenses incurred by the (v) We will reimburse the "insured" "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II COVERED AUTOS of SECTION IV BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdictionof while any trade sanction, em- have used up the applicable limit bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re- and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered "auto". local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will coverage. not invalidate the coverage afforded by this policy, but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada. We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto" is a covered "auto" for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- ranty; G. WAIVER OF DEDUCTIBLE GLASS and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one "loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE LOSS OF SECTION IV BUSINESS AUTO CONDITIONS: USE INCREASED LIMIT Your duty to give us or our authorized representa- tive The following replaces the last sentence of Para- prompt notice of the "accident" or "loss" ap- graph A.4.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or "loss" is known TION III PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner (if you are a partnership); $750 for any one "accident". (c) A member (if you are a limited liability com- I. PHYSICAL DAMAGE TRANSPORTATION pany); EXPENSES INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager (if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization); or SECTION III PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- AGE: tice of the "accident" or "loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ered "auto" of the private passenger type. of SECTION IV BUSINESS AUTO CONDI- TIONS:J. PERSONAL PROPERTY The following is added to Paragraph A.4., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident" parel and other personal property which is: or "loss", provided that the "accident" or "loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- lect Theof following is added to Paragraph B.2., Con- additional premium or exercise our right cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV BUSINESS AUTO CONDITIONS: Page 4 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com Greiner Electric LLC & KBK Mgmt Co In 12456 Dumont Way Littleton, CO 80125 CCIG 155 Inverness Drive West Englewood, CO 80112 (303) 799-0110 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P ROSSIGNB - Underwriter 09/24/2019 10:36:21 4006279 54699281 359-B NCCI #: WC000313B Policy #: 4006279 ENDORSEMENT: Blanket Waiver of Subrogation Effective Date:October 1, 2019 Expires on: October 1, 2020 Pinnacol Assurance has issued this endorsement September 24, 2019 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. Policy Number: 16N64338 Policy Number: 16N64338 Policy Number: 16N64338 3. The Products-Completed Operations Aggre- gate Limit shown in the Declarations is the most we will pay under Coverage A for damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard". Any payments made for such damages will not reduce the Total Aggregate Limit, the General Aggregate Limit, the Designated Project Aggregate Limit for any "project" or the Designated Location Aggregate Limit for any "location". 5. The following is added to the DEFINITIONS Section: "Location" means any designated location shown in the Schedule – Limits Of Insurance And Designated Projects and Locations that is owned by or rented to you. For the purposes of determining the applicable aggregate limit of insurance, each "location" that includes a premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway or waterway, or by a right-of- way of a railroad, will be considered a single "location". "Project" means any designated project shown in the Schedule – Limits Of Insurance And Designated Projects And Locations that is away from premises owned by or rented to you and at which you are performing operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes a premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway or waterway, or by a right-of- way of a railroad, will be considered a single "project". CG D4 69 02 19 © 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Project Aggregate Limit for the applicable "project". Such payments will not reduce the Total Aggregate Limit, the General Aggregate Limit described in Paragraph 2.d. below, the Designated Project Aggregate Limit for any other "project" or the Designated Location Aggregate Limit. c. Subject to the Total Aggregate Limit described in Paragraph 2.a. above, the Designated Location Aggregate Limit shown in the Schedule – Limits Of Insurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The Designated Location Aggregate Limit is the most we will pay for the sum of: (a) Damages under Coverage A because of "bodily injury" and "property damage" caused by "occurrences"; and (b) Medical expenses under Coverage C for "bodily injury" caused by accidents; that can be attributed only to operations at a single "location". (2) The Designated Location Aggregate Limit applies separately to each "location". (3) The Designated Location Aggregate Limit does not apply to damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard". Instead, the Products-Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (4) The Designated Location Aggregate Limit does not apply to damages ssunder Coverage B. Instead, the General Aggregate Limit described in Page 2 of 3 © 2017 The Travelers Indemnity Company. All rights reserved. CG D4 69 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 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. 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 have ADDITIONAL INSURED provisions or 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 12/23/2019 (720) 212-2052 25615 Greiner Electric LLC; Greiner Electric of Wyoming, LLC 12456 N. Dumont Way Littleton, CO 80125 36161 41190 A 1,000,000 X CO9N997650COF19 10/1/2019 10/1/2020 300,000 10,000 1,000,000 2,000,000 2,000,000 B 1,000,000 X 8109N92110819 10/1/2019 10/1/2020 B 10,000,000 CUP9020X0761926 10/1/2019 10/1/2020 10,000,000 10,000 C 4006279 10/1/2019 10/1/2020 1,000,000 N 1,000,000 1,000,000 B Contractor's Equip QT6309006X291TIL19 10/1/2019 Deductible $1,000 398,880 B Leased/Rented Equip QT6309006X291TIL19 10/1/2019 10/1/2020 Deductible $1,000 450,000 RE: Contract Renewal, 8192 Electrical Services 2015 As required by written contract or written agreement, The City of Fort Collins is included as Additional Insured under General Liability and Automobile Liability The City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 GREIELE-01 DENESEB CCIG 155 Inverness Drive West Englewood, CO 80112 Teri Vallejos, CIC Teri.Vallejos@thinkccig.com Charter Oak Fire Insurance Co Travelers Prop. & Casualty Pinnacol Assurance X 10/1/2020 X X X X X X X X