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Home My WebLink About20163128.tiffEsther Gesick From: Deanne Norris Sent: Friday, September 30, 2016 9:24 AM To: CTB Subject: Communications Agenda Attachments: 0630_001. pdf This is an updated Certificate of Liability for Varra Companies. This is an addition to Tyler Doc #2015-1021. Thank you, Deanne Norris Budget/Finance Manager Weld County Public Works 1111 H Street, Greeley, CO 80631 970-400-3776 DNorris@co.weld.co.us Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: SVC-PW109-05255@co.weld.co.us [mailto:SVC-PW109-05255@co.weld.co.us] Sent: Friday, September 30, 2016 8:35 AM To: Deanne Norris <dnorris@co.weld.co.us> Subject: Attached Image 2016-3128 /°-5-0201 b 1 E.,G O0 -7g ACORD. Client#: 33752 VARCOMPC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/27/2016 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 Holmes Murphy -Colorado 7600 East Orchard Rd, Ste 330 South Greenwood Village, CO 80111 INSURED Varra Companies, Inc. 8120 Gage Street Frederick, CO 80516 CONTACT NAME: PHONE 515 223-6800 (A/C, No, Ext): E-MAIL ADDRESS: FAX LA/q,No): INSURER(S) AFFORDING COVERAGE INSURERA: Phoenix Insurance Company INSURER B: Travelers Property Casualty Co. INSURER C . Indian Harbor Insurance Company INSURER D : Charter Oak Fire Insurance Comp INSURER E : Travelers Indemnity Co. of Amer INSURER F : NAIC # 25623 39357 36940 25615 25666 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY T EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEE INSR ._.. ADDL SURF ..,.... LTR TYPE OF INSURANCE INSR VVVD I POLICY NUMBER A XF COMMERCIAL GENERAL LIABILITY X , X 6306A650550 CLAIMS -MADE Xi OCCUR B E C C GENT AGGREGATE LIMIT APPLIES PER: PRO - POLICY I Ai JECT i X LOC OTHER' __.. _... AUTOMOBILE LIABILITY X ANY AU.10 ALL OWNED AUTOS X HIRED AUTOS x UMBRELLA LIAR EXCESS MB SCHEDULED AUTOS NON -OWNED AUTOS X I OCCUR CLAIMS -MADE i DEC X RETENTION $10000 WORKERS COMPENSATION AND EMPLOYERS LIABILITY I ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Contr. Profess Contr Pollut X NIA X 8106A650550 CUP6A650550 P6A650550 UB5D768436 PEC0048317 PEC0048317 N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, N REDUCED BY PAID CLAIMS. POLICY EFF r POLICY EXP LIMITS (MM/DDlYYYY)II1MM/DDlYYYY) 10/01/2016 10/01/2017 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PRFMISFS (Fe occurrence) $300,000 MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG 10/01/2016 10/01/2017 ECs COMBINED SINGLE LIMIT Lacc+dentj.--- -- BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Por accident). 10/01/2016 10/01/2011 EACH OCCURRENCE AGGREGATE 10/01/2016!10/01/2017 X,.ginTUTE I EN" E L EACH ACCIDENT $1,000,000 E L DISEASE EA EMPLOYEE $1,000,000 EL. DISEASE -POLICY LIMIT $1,000,0.00 10/01/2016 10/01/201/ $1,000,000 claim/agg 10/01/2016 10/01/2017 $1,000,000 claim/agg $10,000 $1,000,000 $4,000,000 $ 2,000,000 $ $1,000,000 $5,000,000 $5,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may tee attached If more space Is required) REF: Project - Bid B1500095 The following are additional insureds on General Liability if required by written contract and coverage applies as respects work performed by the insured for the additional insured. All terms and conditions of the policy apply. The general liability coverage is primary and non-contributory per the policy terms and conditions when required by written contract. Additional Insured: Weld County, Dept of Public Works Additonal insured is included on automobile liability only to the extent they meet the (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Weld County Public Works Pavement Management 1111 H Street P 0 Box 758 Greeley, CO 80632-0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE e4 ACORD 25 (2014/01) 1 of 2 #S237880/M237789 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD HANL1 DESCRIPTIONS (Continued from Page 1) definition of an insured in the policy, which provides in pertinent part that an insured includes anyone liable for the conduct of an insured but only to the extend of that liability. All coverage terms, conditions and exclusions of the policy apply. Consult the policy to determine the extent of coverage if any. The workers compensation, general liability, auto liability and umbrella policies include a waiver of subrogation in favor of the additional insured only if required by written contract. Cancellation to additional insured is 30 days except 10 days for non-payment of premium as provided by policy forms. SAGITTA 25.3 (2014/01) 2 of 2 #S237880/M237789 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 Il) is amended to Include any person or organization that you agree In a "written contract requiring Insurance" to include as en additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the Injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring Insurance" applies. The person or organization does not qualify as an additional Insured with respect to the Independent acts or omissions of such person or organization, 2. The Insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section Ili •--Limits Of insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: I. The preparing, approving, or falling to prepare or approve, maps, shop draw- - legs, opinions, reports, surveys, Hold or- dem or change orders, or the preparing, approving, or falling to prepare or ap- provo, drawings and specifications; and ii_ Supervisory, Inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property -damage" caused by "your work" and included in the "products-compieted op- erations hazard" unless the "written contract requiring insurance" specifically requires you" to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that Is available to the additional insured for a loss we cover under this endorsement However, if the "written contract requiring Insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this Insurance is primary to "other Insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other Insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other In- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional Insured under 'such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional Insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should Include: Ca D2 46 08 05 © 2.005 The St. Paul Travelers Companies, Inc, Pagel of 2 ,(E'. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INTERNATIONAL x END 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 Port,, 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 - ego description only. Limitations and exclusions may apply to these coverages. Road ell the provisions of this en- dorsement and the rest of your policy carefully to determine rights, dillies, and what is arid is not covered. A. Broadened Named insured B. Blanket Additional insured.— Broad Form Vendors C. Limited Worldwide Liability Coverage In- demnity Basis D. Damage To Premises Rented To You • Perlis of fire, explosion, lightning, smoke, water • Limit Increased to $300,000 Blanket Waiver of Subrogation F. Blanket Additional Insured Owners, Manag- ers or Lessors of Premises G. Blanket Additional Insured — Lessors of Leased Equipment H. Incidental Medical Malpractice 1. Personal injury --Assumed by Contract J. Amended Bodily injury Definition PROVISIONS A. BROADENED NAMED INSURED 1. The following is added to SECTION II WHO IS AN ENSURED: Any organization, other than a partnership or joint venture, over which you maintain owner- ship or majority interest on the effective date of the policy qualifies as a Named Insured. However, coverage for any such organization will cease as of the date during the policy pry rlod that you no longer maintain ownership of, or majority interest in, such organization. 2. The following replaces Paragraph 4.a. of SECTION II—WHOIS AN INSURED: K. Bodily Injury to Co -Employees end Co - Volunteer Workers L Aircraft Chartered with Crew M. Non -Owned Watercraft-- Increased from 25 feet to 50 feet N. increased Supplementary Payments • Cost of bail bonds Increased to $2,500 Loss of earnings Increased to $500 per day O. Medical Payments --- limit increased to $10,000 per person P. Knowledge and Notice of Occurrence or Of- fense Q. Unintentional Omission R. Reasonable Force — Bodily Injury or Property Damage S. Transportation Expenses For Repatriation or Relocation of Injured Or Sick Employees a. Coverage under this provision is afforded only until the 1130th day after you acquire or form the organization or the end of the policy period, whichever is earlier, unless reported in writing to us within 180 days. B. BLANKET ADDITIONAL. INSURED — BROAD FORNI VENDORS The following is added to SECTION II -- WHO iS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on • this Coverage Part is an insured, but only with re- spect to liability for "bodily Injury" or "property damage" that: CG D4 58 10 08 O2008 Thy+Travelers Centpenles, Inc. Page 1 of 9 COMMERCIAL GENERAL LIABILITY behalf of such premises owner, manager or lessor. The Insurance provided to such premises owner, manager or lessor is excess over any valid and colloctibte other insurance available to such 'premises owner, manager or lessor, unless you have agreed in a written contract for this insurance to apply an a primary or contributory basis. 0, BLANKET ADDITIONAL INSURED - LESSORS OF LEASED EQUIPMENT ' The following is added to SECTION It •- WHO IS AN INSURED: Any person or organization that is an equipment lessor and• that you have agroed in a written con- tract or agreement to include as an additional in, sired on this Coverage Part Is an insured, but only with respect to liability for "bodily Injury", "property damage", "personal injury" or "advartis•• Ing injury" that: a. Is "bodily injury" or "property damage" caused by an "occurrence:" that lakes place, ur "per- sonal injury" or "advertising injury" caused by an offense that Is committed, after you have signed and executed that contract or agree- ment; and b. Is caused, In whole or in part, by your acts or omissions in the maintenance, operation or use by you of equipment leased to. you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be the limits which you agreed to provide In the written contract or agreement, or the limits shown on the Decla- rations of this Coverage Pant, whichever are 'less. b, The Insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" caused by an "occur - ranee" that takes place, or "personal injury" or "advertising injury" caused by en offense that is committed, atter the equipment lease ex- pires. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment tosser, unless you have agreed in a written contract for this insurance to apply on a pri- mary or contributory basis. H. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" in the DEFINITIONS Section: Unless you ore in the business or occupation of providing professional health care services, "occurrence" also moons an act or omisslon committed in providing or falling to provide "incidental medical services" to a person. 2. The following Is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing.service or treatment, advice or instruction, or• the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies appliances; e. First aid; or d. "Good Samaritan services". "Good Samaritan services" means any emer- gency medical scrvlees for which no compen- sation Is demanded orrc ceived. 3. Tho following is added to Paragraph 2.a.(1). of SECTION II -- WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health cam services, Paragraphs (1)(a), (b), (c) and (ci) above do not apply to any "bodily Injury" arising out of any providing or foiling to provide "incidental medical crevices" by any of your "employ- ees", other than an employed doctor. Any such "employees" providing or failing to pro- vide "incidental medical services" during their work hours for you will be deemed to be act- ing within the scope of their employment by you or performing duties related to the con- duct of your business. 4. The following exclusion Is added to Para- graph 2., Exclusions, of SECTION I COV- ERAGES -- COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed by, or with the knowledge or consent of, the insured. 5. The following is added to Paragraph 5. of SECTION Ill LIMITS OF INSURANCE: or CG 04.58 10 08 O2008 The Travelers Companies, Mo. Page 5 of 9 Hello