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HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCEANY 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 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTO ELITE EXTENSION CA7450(11-15) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 1 of 4 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The BUSINESS AUTO COVERAGE FORM is amended to include the following clarifications and extensions of coverage. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. TEMPORARY SUBSTITUTE AUTO PHYSICAL DAMAGE Section I – Covered Autos Paragraph C. Certain Trailers, Mobile Equipment, and Temporary Substitute Autos is amended by adding the following: If Physical Damage Coverage is provided by this coverage form for an "auto" you own, the Physical Damage Coverages provided for that owned "auto" are extended to any "auto" you do not own while used with the permission of its owner as a temporary substitute for the covered "auto" you own that is out of service because of breakdown, repair, servicing, "loss" or destruction. The coverage provided is the same as the coverage provided for the vehicle being replaced. B. BLANKET ADDITIONAL INSURED Section II – Covered Autos Liability Coverage, A.1. Who Is An Insured is amended by adding the following: Any person or organization who is a party to a written agreement or contract with you in which you agree to provide the type of insurance afforded under this Business Auto Coverage Form. This provision applies to claims for “bodily injury” or “property damage” which occur after the execution of any written agreement or contract. C. EMPLOYEES AS INSUREDS The following is added to the Section II – Covered Autos Liability Coverage, Paragraph A.1. Who Is An Insured Provision: Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. D. EMPLOYEE HIRED AUTOS 1. Changes In Covered Autos Liability Coverage The following is added to the Who Is An Insured Provision: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. 2. Changes In General Conditions Paragraph 5.b. of the Other Insurance Condition in the Business Auto Coverage Form is replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: a. Any covered "auto" you lease, hire, rent or CA7450(11-15) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 2 of 4 F. SUBSIDIARIES AS INSUREDS Section II – Covered Autos Liability Coverage, A.1. Who Is An Insured is amended by adding the following: Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of this policy. However, “insured” does not include any subsidiary that is an “insured” under any other automobile liability policy or was an “insured” under such a policy but for termination of that policy or the exhaustion of the policy’s limits of liability. G. SUPPLEMENTARY PAYMENTS Section II – Covered Autos Liability Coverage, A.2.a. Coverage Extensions, Supplementary Payments (2) and (4) are replaced by the following: (2) Up to $5,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an “accident” we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the “insured” at our request, including actual loss of earnings up to $500 a day because of time off from work. H. FELLOW EMPLOYEE COVERAGE In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by workers compensation exclusivity rule, or similar protection. The following provision is added: Subparagraph 5. of Paragraph B. Exclusions in Section II Covered Autos Liability Coverage does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. I. TOWING Section III – Physical Damage Coverage, A.2. Towing is replaced with the following: We will pay for towing and labor costs incurred, subject to the following: a. Up to $100 each time a covered “auto” of the private passenger type is disabled; or b. Up to $500 each time a covered “auto” other than the private passenger type is disabled. However, the labor must be performed at the place of disablement. J LOCKSMITH SERVICES Section III – Physical Damage Coverage, A.4. Coverage Extensions is amended by adding the following: We will pay up to $250 per occurrence for necessary locksmith services for keys locked inside a covered private passenger "auto". The deductible is waived for these services. K. TRANSPORTATION EXPENSES Section III – Physical Damage Coverage, A.4. Coverage Extensions Subparagraph a. Transportation Expenses is replaced by the following: CA7450(11-15) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 3 of 4 N. AUTO LOAN OR LEASE COVERAGE Section III – Physical Damage Coverage Paragraph A.4. Coverage Extensions is amended by the addition of the following: In the event of a total "loss" to a covered "auto" which is covered under this policy for Comprehensive, Specified Cause of Loss, or Collision coverage, we will pay any unpaid amount due, including up to a maximum of $500 for early termination fees or penalties, on the lease or loan for a covered "auto", less: 1. The amount paid under the Physical Damage Coverage Section of the policy; and 2. Any: a. Overdue lease/loan payments at the time of the "loss"; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; c. Security deposits not returned by the lessor; d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and e. Carry-over balances from previous loans or leases. Coverage does not apply to any unpaid amount due on a loan for which the covered "auto" is not the sole collateral. O. PERSONAL PROPERTY OF OTHERS Section III – Physical Damage Coverage, A.4. Coverage Extensions is amended by adding the following: We will pay up to $500 for loss to personal property of others in or on your covered “auto.” This coverage applies only in the event of “loss” to your covered “auto” caused by fire, lightning, explosion, theft, mischief or vandalism, the covered “auto’s” collision with another object, or the covered “auto’s” overturn. No deductibles apply to this coverage. P. PERSONAL EFFECTS COVERAGE Section III – Physical Damage Coverage, A.4. Coverage Extensions is amended by adding the following: We will pay up to $500 for "loss" to your personal effects not otherwise covered in the policy or, if you are an individual, the personal effects of a family member, that is in the covered auto at the time of the "loss". For the purposes of this extension personal effects means tangible property that is worn or carried by an insured including portable audio, visual, or electronic devices. Personal effects does not include tools, jewelry, guns, money and securities, or musical instruments Q. EXTRA EXPENSE FOR STOLEN AUTO Section III – Physical Damage Coverage, A.4. CA7450(11-15) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 4 of 4 S. AIRBAG COVERAGE Section III – Physical Damage Coverage, B.3.a. Exclusions is amended by adding the following: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. T. NEW VEHICLE REPLACEMENT COST The following is added to Paragraph C. Limit Of Insurance of Section III – Physical Damage Coverage In the event of a total “loss” to your new covered auto of the private passenger type or vehicle having a gross vehicle weight of 20,000 pounds or less, to which this coverage applies, we will pay at your option: a. The verifiable new vehicle purchase price you paid for your damaged vehicle, not including any insurance or warranties. b. The purchase price, as negotiated by us, of a new vehicle of the same make, model, and equipment, or most similar model available, not including any furnishings, parts, or equipment not installed by the manufacturer or their dealership. c. The market value of your damaged vehicle, not including any furnishings, parts, or equipment not installed by the manufacturer or their dealership. We will not pay for initiation or set up costs associated with a loans or leases. For the purposes of this coverage extension a new covered auto is defined as an "auto" of which you are the original owner that has not been previously titled which you purchased less than 180 days prior to the date of loss. U. LOSS TO TWO OR MORE COVERED AUTOS FROM ONE ACCIDENT Section III – Physical Damage Coverage, D. Deductible is amended by adding the following: If a Comprehensive, Specified Causes of Loss or Collision Coverage “loss” from one “accident” involves two or more covered “autos”, only the highest deductible applicable to those coverages will be applied to the “accident”. If the application of the highest deductible is less favorable or more restrictive to the insured than the separate deductibles as applied in the standard form, the standard deductibles will apply. This provision only applies if you carry Comprehensive, Collision or Specified Causes of Loss Coverage for those vehicles, and does not extend coverage to any covered “autos” for which you do not carry such coverage. V. WAIVER OF DEDUCTIBLE – GLASS REPAIR OR REPLACEMENT Section III – Physical Damage Coverage, D. Deductible is amended by adding the following: If a Comprehensive Coverage deductible is shown in the Declarations it does not apply to the cost of repairing or replacing damaged glass. 7501 E Lowry Blvd Denver, CO 80230-7006 303-361-4000 / 800-873-7242 www.pinnacol.com Colorado Moisture Control Inc 4950 E. 56th Ave. Commerce City, CO 80022 Hub International/BW 1125 17th St. Ste 900 Denver, CO 80202 (970) 223-0924 7501 E Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P SANJRUND - Underwriter 04/27/2017 11:02:28 4019334 49002898 359-B NCCI #: WC000313B Policy #: 4019334 ENDORSEMENT: Blanket Waiver of Subrogation Effective Date: April 27, 2017 Expires on: May 1, 2018 Pinnacol Assurance has issued this endorsement April 27, 2017. Construction and Natural Resources Center of Excellence Phone (303) 361-4200 / (866) 820-6129 Fax (303) 361-5200 / (888) 329-2216 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. W. DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS Section IV – Business Auto Conditions, A.2. Duties In The Event Of Accident, Claim, Suit Or Loss is amended by adding the following: Your obligation to notify us promptly of an “accident”, claim, “suit” or “loss” is satisfied if you send us the required notice as soon as practicable after your Insurance Administrator or anyone else designated by you to be responsible for insurance matters is notified, or in any manner made aware, of an “accident”, claim, “suit” or “loss”. X. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY Subparagraph 5. of Paragraph A. Loss Conditions of Section IV Business Auto Conditions is deleted in its entirety and replaced with the following. Transfer Of Rights Of Recovery Against Others To Us If any person or organization to or for whom we make payment under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after "accident" or "loss" to impair them. However, we waive any right of recovery we may have against any person, or organization with whom you have a written contract, agreement or permit executed prior to the "loss" that requires a waiver of recovery for payments made for damages arising out of your operations done under contract with such person or organization. Y. UNINTENTIONAL FAILURE TO DISCLOSE EXPOSURES Section IV – Business Auto Conditions, B.2. Concealment, Misrepresentation, Or Fraud is amended by adding the following: If you unintentionally fail to disclose any exposures existing at the inception date of this policy, we will not deny coverage under this Coverage Form solely because of such failure to disclose. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non- renewal. Z. MENTAL ANGUISH Section V – Definitions, C. is replaced by the following: “Bodily injury” means bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from bodily injury, sickness or disease. AA. LIBERALIZATION If we revise this endorsement to provide greater coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. Coverage Extensions is amended by adding the following: We will pay up to $1,000 for the expense incurred returning a stolen covered "auto" to you because of the total theft of such covered "auto". Coverage applies only to those covered "autos" for which you carry Comprehensive or Specified Causes Of Loss Coverage. R. RENTAL REIMBURSEMENT Section III – Physical Damage Coverage, A.4. Coverage Extensions is amended by adding the following: 1. This coverage applies only to a covered "auto" for which Physical Damage Coverage is provided on this policy. 2. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. 3. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days. a. The number of days reasonably required to repair or replace the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you; or b. 30 days. 4. Our payment is limited to the lesser of the following amounts: a. Necessary and actual expenses incurred; or b. $75 per day, subject to a $2,250 limit. 5. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. 6. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage – Transportation Expense Coverage Extension included in this endorsement. 7. Coverage provided by this extension is excess over any other collectible insurance and/or endorsement to this policy. (1) We will pay up to $75 per day to a maximum of $2,500 for temporary transportation expense incurred by you because of the total theft of a covered “auto” of the private passenger type. We will pay only for those covered “autos” for which you carry either Comprehensive or Specified Cause Of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy’s expirations, when the covered “auto” is returned to use or we pay for its “loss”. (2) If the temporary transportation expenses you incur arise from your rental of an “auto” of the private passenger type, the most we will pay is the amount it costs to rent an “auto” of the private passenger type which is of the same like kind and quality as the stolen covered “auto”. L. AUDIO, VISUAL, AND DATA ELECTRONIC EQUIPMENT COVERAGE ADDED LIMITS Audio, Visual, And Data Electronic Equipment Coverage Added Limits of $5,000 Per “Loss” are in addition to the sublimit in Paragraph C.1.b. of the Limits Of Insurance provision under Section III – Physical Damage Coverage. M. HIRED AUTO PHYSICAL DAMAGE Section III – Physical Damage Coverage, A.4. Coverage Extensions is amended by adding the following: If hired “autos” are covered “autos” for Liability Coverage, and if Comprehensive, Specified Causes of Loss, or Collision coverage is provided for any “auto” you own, then the Physical Damage coverages provided are extended to “autos” you hire, subject to the following limit and deductible: (1) The most we will pay for loss to any hired “auto” is the lesser of Actual Cash Value or Cost of Repair, minus the deductible. (2) The deductible will be equal to the largest deductible applicable to any owned “auto” for that coverage. No deductible applies to “loss” caused by fire or lightning. (3) Subject to the above limit and deductible provisions, we will provide coverage equal to the broadest coverage applicable to any covered “auto” you own. We will pay up to $1,000, in addition to the limit above, for loss of use of a hired auto to a leasing or rental concern for a monetary loss sustained, provided it results from an "accident" for which you are legally liable. borrow; and b. Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". E. NEWLY FORMED OR ACQUIRED ORGANIZATIONS Section II – Covered Autos Liability Coverage, A.1. Who Is An Insured is amended by adding the following: Any organization which you acquire or form after the effective date of this policy in which you maintain ownership or majority interest. However: (1) Coverage under this provision is afforded only up to 180 days after you acquire or form the organization, or to the end of the policy period, whichever is earlier. (2) Any organization you acquire or form will not be considered an “insured” if: (a) The organization is a partnership or a joint venture; or (b) That organization is covered under other similar insurance. (3) Coverage under this provision does not apply to any claim for “bodily injury” or “property damage” resulting from an “accident” that occurred before you formed or acquired the organization. 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 4/27/2017 (303) 252-3761 (866) 243-0727 12537 Colorado Moisture Control, Inc. 4950 East 56th Avenue Commerce City, CO 80022 25186 19445 41190 13551 A 1,000,000 X X ATNATL1720325 05/01/2017 05/01/2018 50,000 Excluded 1,000,000 2,000,000 2,000,000 B 1,000,000 X X 5X46834-18 05/01/2017 05/01/2018 C 5,000,000 EBU032713233 05/01/2017 05/01/2018 5,000,000 10,000 D X 4019334 05/01/2017 05/01/2018 1,000,000 N 1,000,000 1,000,000 E Pollution Liability AHSECC1031301 05/01/2017 Limit 1,000,000 Project: Service Agreement, 8129 Roofing Services City of Fort Collins, its officers, agents and employees are additional insureds for General Liability. Waiver of subrogation in favor of the additional insureds is applicable to General Liability and Workers Compensation. City of Fort Collins Director of Purchasing and Risk Management PO Box 580 Fort Collins, CO 80522 COLOMOI-01 PVIANZON HUB International Insurance Services (COL) 1125 17th St, Suite 900 Denver, CO 80202 Barb Arnold Barbara.arnold@hubinternational.com United Specialty Insurance Company EMC Property & Casualty National Union Fire Insurance Company of Pittsburgh, PA Pinnacol Assurance Company Hamilton Specialty Insurance Company, Hamilton USA X 05/01/2018 X X X X X X X X X X