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Home My WebLink AboutUSI POWERS INSULATION - INSURANCE CERTIFICATEACORD® I- CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD/YYYY) 06/29/2015 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 7th Street, Suite 1400 CONTACT NAME: PHONE FAX / Ns, ExU: ___.__ __ _ ____ __ (A/C, Not Minneapolis, MN 55402-2400 Attn: Minneapolis.CertRequest@marsh.com Fax 212-948-0114 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: New Hampshire Insurance Company 23841 Powers _ INSURED USI Powers Insulation INSURER B : Lexington Insurance Company 19437 - — 2645 Durango Drive INSURER C : INSURER D : Colorado Springs, CO 80910 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-005893447-04 REVISION NUMBER:1 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. -DULEXP INSR TYPE OF INSURANCE I INSD S VD POLICY NUMBER MMIDD YYYY MMI- LTR DD YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 538 83 24 07/01/2015 07/01/2016 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE OCCUR TED PREM SESOEa ocicu ence $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRO- LOC POLICY � PRODUCTS - COMP/OP AGG $ 4,000,000 $ OTHER A AUTOMOBILE LIABILITY CA 5101689 07/01/2015 07/01/2016 COMBINED SINGLE LIMIT Ea ccdent a g 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) ALL OWNED SCHEDULED X AUTOS AUTOS X X NON -OWNED HIRED AUTOS AUTOS $ (Per accident) PROPERTY DAMAGE $ $ B X UMBRELLA LIAB X OCCUR 006761832 07/01/2015 07/01/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DIED I X I RETENTION$25,000 $ A A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA A WC 034157 322 (AIDS) WC 034157 323 NC,UT ( ) WC 034157 324 AZ ( ) 07/01/2015 07/0112015 07/01/2015 07/01/2016 07/0112016 07/01/2016 X I STERORH E.L. EACH ACCIDENT $ 1,000,000 _ E L. DISEASE - EA EMPLOYEE $ 1,000,000 E L DISEASE -POLICY LIMIT $ 1,000,000 A If yes, describe under DESCRIPTION OF OPERATIONS below WC 034 157 325 CA ( ) 07/01/2015 07/01/2016 A Workers Compensation WC 034157 326 (FL) 0710112015 07/01/2016 SEE ABOVE A Workers Compensation WC 034 157 327 (NJ) 17111/2115 07/01/2016 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Project: Ft. Collins Senior Center, 7534 Raintree Drive, Ft. Collins, Colorado. Certificate Holder and Ft. Collins Senior Center are included as additional insureds (except Workers' Compensation) where required by written contract. Waiver of subrogation is applicable where required by written contract. GtK I IFIGA 1 It: HULUtK %,HIVI,CLLA I IVIV City of Ft. Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 N. Mason St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ft. Collins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _J*tgk% ea" U 1988-2014 AGUKU GUKPL)KA I IUN. All rlgntS reservea. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POi ICY NUMBER: CA 5101689 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED INSURED This endorsement modifies insurance provided wider the follo%vinq: BUSINESS AUTO COMAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM Alith respect to Coverage provided by this end0l'se"7WrIt, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or orgpnization(s) who are "insureds" under the Who Is An Insure(; Provision of the Coverage Form. This endorsement does not after coverage provided in the Coverage Form. This endorsement c1iiijigus the policy effective On the InCePbon date of the poliry unless another date is indicated "ow. Effective 711120 15 lamed Insured: UNITED SUBCONTRACTORS. INC. SCHEDULE Name of Personisl or -Organization(s): WHERE REQUIRED BY WRITTEN CONTRACT I.Authorized Representative) {If no OntrY appears above, information required to con-trihe-te be endorsement. will this linns As applicable to the endorsement,} i . shown in the Declara- Each person or Dr9al)ization ,hown 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 15 An Insured Provision contained in, Section 11 of the Coverage Form, CA 20 48 02 99 Copyright, Insurance Services Office, Inc i998 Page 1 of 1 POLICY NUMBER: GL 538 83 24 COMMERCIAL GENERAL LIABILITY CG20100413 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 Oraanization(s) Location(s) Of Covered O Rerations ANY PERSON OR ORGANIZATION WHOM YOU I PER THE CONTRACT OR AGREEMENT BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. IInformation required to complete this Schedule, if not shown above, will be shown in the Declarations. J A. 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", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The arts or omissions of those acting on your behalf, - in the performance of your ongcincg operations for the additional insured(s) at the locations) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds; the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 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 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 organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the 0 applicable limits of Insurance shown in the Declarations. CG 20 10 04 13 * Insurance Services Office, Inc., 2012 Page 1 of 1 ENDORSE NIENT Tnis endarsament. effective 12,01 AM, 7/1/2015 fermis a fart of policy No. CA51OW9 iss.jef to UNITEL) SUBCON7RACTCRS, INC. by NEW HAMPSH I RE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endersement modifies insurance prowrded under the following: BUSINESS AUTO COVERAGE: !PO RM 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 anv right of recover we have against any person or organization with whore 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: (1) The "accident" or "loss" is due to ope.rations undertaken in accordance with the contract existing between you and Such person or oryanixatioii; and (2) The contract or agreement was entered into prior to any "accident" rx "loss". No waiver of the right of recovery wiii 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. r;FITHOR':ZEl7 > EPRESENTATIVE 62897 6'051 POLICY NUMBER: GL 538 83 24 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 follov�ing: 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 shovai in the Declarations. . . .. .... .................. . . . .................. The foliawing is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Sec- tion IV - Conditions: We vi,,aive arty right of recovery �Ae may have against the person or organ4ation shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing opera- tions or "your work" done tinder a rontract with tha!r person or organization and included in the .products-curnpieted operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0 Insurance Servi"'s Office, lnr., 2008 Page 1 of 1 0 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 foNow-ing "adaching cause' need be corn*led only when this endorsement is issued subw4uenf 10 rwe0-W3fiOn Of the PchCV) This endorsement, effective 12:01 AM QN01/2015 forms a part of Policy No, WC 0341573' .12 Issued to UNITED SUBCONTRACTORS INC By NEW HAMPSHIRE INSURANCE COMPANY PrOrniUrn We have the right to recover our payments from anyone liable for an inlury 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 Nvork 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 TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER ANY CONTRACT OAGREEMENT YOU ENTER INTO PRIOR TO THE OCCURENCE OF LOSS. This form is not applicable. in California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Tennessee, Texas, Utah, or Washington. WC 00 03 13 Countersigned by Authorized Representative