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HomeMy WebLinkAbout210453 SOUTH PLATTE CONSTRUCTION2022-2023 MASTER - City of Wheat Ridge_Page_01WESTCON-03 MARGARETM AC'OR"' CERTIFICATE OF LIABILITY INSURANCE �..-■-' DATE(MMIDDIYYYY) 5/24/2022 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 SU BROGATION 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 CONTACT Carrl Proctor NAME: PHONE FAX (A/C, No, Ext): (720 ) 212-2052 (A/C, No): CCIG 155 Inverness Drive West Englewood, CO 80112 ARESS, Carri.Proctor@thinkccig.com INSURERS AFFORDING COVERAGE NAIC # 3/1/2023 INSURER A: Selective Insurance Company of America 12572 INSURED INSURER B: Plnnacol Assurance 41190 Western Consulting Company LLC dba South Platte INSURER C: Travelers Casualty and Surety Company of America 31194 Construction Group LLC 3833 Quay Street INSURER D: Nautilus Insurance Company 17370 INSURER E: $ 2,000,000 Wheat Ridge, CO 80033 INSURER F: $ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X]OCCURS 2324976 2/17/2022 3/1/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 500 000 $ GENT MED EXP (Any oneperson) $ 15'000 PERSONAL &ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY 1X PET 1:1LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY S 2324976 2/17/2022 3/1/2023 COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILYINJURY Perperson) $ BODILY INJURY Per accident $ PeOaccident DAMAGE $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE S 2324976 2/17/2022 3/1/2023 EACH OCCURRENCE $ 2'000'000 AGGREGATE $ 2'000'000 DED X RETENTION $ 0 $ IS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY OFFICER/MEMBEER/EXCLUDED? ECUTIVE �Y (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4228876 3/1/2022 3/1/2023 XPER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE- EA EMPLOYEE $ 1'000'000 E.L. DISEASE- POLICY LIMIT 1,000,000 $ C D Crime Incls Burglary Pollution/Prof Liab 107399973 CPP203428211 3/10/2022 3/10/2022 3/10/2025 3/10/2023 Limit: Per Claim 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of Wheat Rid City Ridge THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7500 W. 29th Avenue Wheat Ridge, CO 80033 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Contracting, Installation, Service and Repair General Liability Extended ElitePac° Endorsement COMMERCIAL GENERAL LIABILITY CG 79 88 01 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. BLANKET ADDITIONAL INSUREDS a. Ongoing Operations SECTION II — WHO IS AN INSURED is amended to include as an additional insured: Any person or organization for whom you are performing operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy, and 2. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph 1. above, Such person or organization is an additional insured only with respect to liability arising out of your ongoing operations performed under that contract, agreement, or permit when that contract, agreement, or permit requires the additional insured be added with respect to liability arising out of your ongoing operations. If the written contract, written agreement, or written permit does not require that the additional insured be added with respect to liability arising out of your ongoing operations, then such person or organization is an additional insured only with respect to "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by your ongoing operations performed under that contract, agreement, or permit. b. Completed Operations SECTION II — WHO IS AN INSURED is amended to include as an additional insured: Any person or organization for whom you are performing or have performed operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy, and 2. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph 1. above, Such person or organization is an additional insured only with respect to their liability arising out of "your work" performed under that contract, agreement, or permit and included in the "products -completed operations hazard" when that contract, agreement, or permit requires the additional insured be added with respect to liability arising out of "your work" performed under that contract, agreement, or permit and included in the "products -completed operations hazard". Copyright, 2018 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSURED's COPY CG 79 88 01 19 Pagel of 3 If the written contract, written agreement, or written permit does not require that the additional insured be added with respect to liability arising out of "your work" performed under that contract, agreement, or permit and included in the "products -completed operations hazard", then such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by "your work" performed under that contract, agreement, or permit and included in the "products -completed operations hazard". c. The coverages provided in Paragraphs a. and b. do not apply unless the written contract or written agreement has been signed by the Named Insured or written permit issued prior to the "bodily injury", "property damage" or "personal and advertising injury". d. Exclusions (1) With respect to the insurance afforded to additional insureds under a. Ongoing Operations the following is added to 2. Exclusions under SECTION I — COVER- AGE A— BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: This insurance does not apply to "bodily injury", "property damage", or "personal and advertising injury" occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed, or (b) 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 contrac- tor or subcontractor engaged in perform- ing operations for a principal as a part of the same project. (2) With respect to the insurance afforded to these additional insureds under a. Ongoing Operations and b. Completed Operations, the following is added to 2. Exclusions under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: This insurance does not apply to: "Bodily injury", "property damage", or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications, or (b) Supervisory, inspection, architectural or engineering activities. e. Conditions With respect to the insurance afforded to these additional insureds under a. Ongoing Operations and b. Completed Operations the following is added to Paragraph 4. Other Insurance, a. Primary Insurance under SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is primary and will not contribute with any other insurance available to an additional insured under this coverage part provided that: (1) The additional insured is a Named Insured under such other insurance. (2) You have agreed in a written contract, written agreement or written permit to include that additional insured on your General Liability policy on a primary and/or non-contributory basis. 2. PROPERTY DAMAGE CARE, CUSTODY OR CONTROL The following is added to Exclusion j. under SECTION I — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Paragraphs (4) and (5) do not apply for the limited purpose of providing the coverage and sub -limits of liability as set forth below. We will pay those sums that the insured becomes legally obligated to pay as damages arising out of "property damage" to: (1) Personal property in the care, custody or control of the insured, and Copyright, 2018 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSURED'S COPY CG 79 88 01 19 Page 2 of 3 (2) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations. The most we will pay under (1) and (2) above in any one "occurrence" or for all damages during any one policy period is a sub -limit of $100,000. These limits are included in and not in addition to the Limits of Insurance shown in the Declarations of the Commercial General Liability Policy. Our right and duty to defend the insured against any "suit" for damages under (1) and (2) above ends when we have used up the applicable sub -limit of liability in the payment of judgments or settlements under it. 3. OTHER INSURANCE AMENDMENT — SUPPLE- MENTAL COVERAGE FOR INSURED'S INVOLVE- MENT IN A CONSOLIDATED (WRAP-UP) IN SUR- ANCE PROGRAM OR SIMILAR PROJECT The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDI- TIONS, Paragraph 4. Other Insurance b. Excess Insurance (1)(a): (v) That is covered by a consolidated (wrap-up) or similar insurance program provided by the prime contractor/project manager or owner of the construction project in which you are involved for your ongoing operations or operations included within the "products -completed operations hazard", unless such consolidated (wrap-up) or similar program is specifically excluded from coverage on this policy. 4. FELLOW EMPLOYEE EXTENSION Under SECTION II — WHO IS AN INSURED Para- graphs 2.a. and 2.a. (1) are replaced by the following: a. Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture, or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. The Employers Liability exclusion (SECTION I — COVERAGES; COVERAGE A, exclusion e.) does not apply to this provision. However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury" or "personal and advertising injury": (a) Arising out of his or her providing or failing to provide professional health care services. 5. CONTRACTUAL LIABILITY (RAILROADS) Definition 9. Insured Contract is amended as fol- lows: Paragraph c. is deleted in its entirety and replaced with the following: Any easement or license agreement, Paragraph f.(1) is deleted in its entirety. 6. CONTRACTUAL LIABILITY AMENDMENT — (PERSONAL AND ADVERTISING INJURY) If it is required in a written contract, written agreement or written permit with the insured that any contractual liability exclusion for Personal Injury be removed from the policy, then Exclusion e. Contractual Liability under COVERAGE B PERSONAL AND ADVERTISING INJURY, 2. Exclusions is deleted in its entirety and replaced with the following: e. Contractual Liability "Personal and advertising Injury" for which the insured has assumed liability in a contract or agreement arising out of an "advertisement". This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement" 7. WAIVER OF GOVERNMENTAL IMMUNITY We will waive, both in the adjustment of claims and in the defense of "suits" against the insured, any governmental immunity of the insured, unless the insured requests in writing that we not do so. Waiver of immunity as a defense will not subject us to liability for any portion of a claim or judgment in excess of the applicable limit of insurance. 8. DAMAGE TO PREMISES RENTED TO YOU The Limit of Insurance for Damage To Premises Rented To You is increased to $1,000,000. Copyright, 2018 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSURED's COPY CG 79 88 01 19 Page 3 of 3 ElitePaw General Liability Extension Endorsement COMMERCIAL GENERAL LIABILITY CG 73 00 01 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement will be amended as shown below. However, if (a) two or more Coverage Parts of this policy, or (b) two or more forms or endorsements within the same Coverage Part apply to a loss, coverage provision(s) with the broadest language will apply, unless specifically stated otherwise within the particular amendment covering that loss. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. COVERAGES - Amendments SECTION I - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY EXCLUSIONS Employer's Liability Amendment (This provision is not applicable in the State of New York). The following is added to Exclusion e. Employer's Liability under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: This exclusion also does not apply to any "temporary worker'. Non -Owned Aircraft, Auto or Watercraft A. Paragraph (2) of Exclusion g. Aircraft, Auto Or Watercraft under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclus- ions is deleted in its entirety and replaced with the following: (2) A watercraft you do not own that is: (a) Less than 26 feet long and not being used to carry persons or property for a charge; or (b) At least 26 feet, but less than 60 feet long, and not being used to carry persons or property for a charge. Any person is an insured who uses or is responsible for the use of such watercraft with your expressed or implied consent. However, if the insured has any other valid and collectible insurance for "bodily injury' or "property damage" that would be covered under this provision, or on any other basis, this coverage is then excess, and subject to Condition 4. Other Insurance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS. B. The following is added to Exclusion g. Aircraft, Auto Or Watercraft under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: This exclusion does not apply to (6) Any aircraft, not owned or operated by any insured, which is hired, chartered or loaned with a paid crew. However, if the insured has any other valid and collectible insurance for "bodily injury' or "property damage" that would be covered under this provision, or on any other basis, this coverage is then excess, and subject to Condition 4. Other Insurance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS. Damage To Premises Rented to You A. The last paragraph of Paragraph 2. Exclusions under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE is deleted in its entirety and replaced with the following: Exclusions c. through n. do not apply to damage by fire, lightning or explosion to premises rented to you or temporarily occupied by you with the permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE. Copyright, 2018 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSURED'S COPY CG 73 00 01 19 Page 3 of 9 B. Paragraph 6. under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: 6. Subject to Paragraph 5. above, the most we will pay under COVERAGE A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning or explosion, while rented to you or temporarily occupied by you with permission of the owner, for all such damage caused by fire, lightning or explosion proximately caused by the same event, whether such damage results from fire, lightning or explosion or any combination of the three, is the amount shown in the Declara- tions for the Damage To Premises Rented To You Limit. C. Paragraph a. of Definition 9. 'Insured contract' under SECTION V - DEFINITIONS is deleted in its entirety and replaced with the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning or explosion to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured contract"; Electronic Data Liability A. Exclusion p. Access or Disclosure Of Confidential Or Personal Information And Data -related Liability under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is deleted in its entirety and replaced by the following: p. Access or Disclosure Of Confidential Or Personal Information And Data -related Liability Damages arising out of (1) Any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information or any other type of nonpublic information; or (2) The loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in Paragraph (1) or (2) above. B. The following paragraph is added to SECTION III - LIMITS OF INSURANCE: Subject to 5. above, the most we will pay under COVERAGE A for "property damage" because of all loss of "electronic data" arising out of any one "occurrence" is a sub -limit of $100,000. SECTION I - COVERAGE C MEDICAL PAYMENTS EXCLUSIONS Any Insured Amendment Exclusion a. Any Insured under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: a. Any Insured To any insured. This exclusion does not apply to: (1) "Not-for-profit members"; (2) "Golfing facility' members who are not paid a fee, salary, or other compensation; or (3) "Volunteer workers". This exclusion exception does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. Product Amendment Exclusion f. Products -Completed Operations Hazard under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: f. Products -Completed Operations Hazard Included within the "products -completed operations hazard". This exclusion does not apply to "your products" sold for use or consumption on your premises, while such products are still on your premises. This exclusion exception, does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. SECTION I - SUPPLEMENTARY PAYMENTS - COVERAGES A AND B Expenses For Bail Bonds And Loss Of Earnings A. Subparagraph 1.b. under SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is deleted in its entirety and replaced with the following: b. Up to $5,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 9 INSUREW S COPY B. Subparagraph 1.d. under SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is deleted in its entirety and replaced with the following: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit', including actual loss of earnings up to $1,000 a day because of time off from work. SECTION II - WHO IS AN INSURED - Amendments Not -for -Profit Organization Members The following paragraph is added to SECTION II - WHO IS AN INSURED: If you are an organization other than a partnership, joint venture, or a limited liability company, and you are a not- for-profit organization, the following are included as additional insureds: 1. Your officials; 2. Your trustees; 3. Your members; 4. Your board members; 5. Your commission members; 6. Your agency members; 7. Your insurance managers; 8. Your elective or appointed officers; and 9. Your "not-for-profit members". However only with respect to their liability for your activities or activities they perform on your behalf. Employees As Insureds Modified A. Subparagraph 2.a.(1)(a) under SECTION II - WHO IS AN INSURED does not apply to "bodily injury" to a "temporary worker" caused by a co -"employee" who is not a "temporary worker". B. Subparagraph 2.a.(2) under SECTION II - WHO IS AN INSURED does not apply to "property damage" to the property of a "temporary worker" or "volunteer worker' caused by a co -"employee" who is not a "temporary worker" or "volunteer worker". C. Subparagraph 2.a.(1)(d) under SECTION II - WHO IS AN INSURED does not apply to "bodily injury" caused by cardio -pulmonary resuscitation or first aid services administered by a co -"employee". With respect to this provision only, Subparagraph (1) of Exclusion 2. e. Employer's Liability under SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY does not apply. Newly Formed Or Acquired Organizations A. Subparagraph 3.a. under SECTION II - WHO IS AN INSURED is deleted in its entirety and replaced with the following: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. However, COVERAGE A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. B. The following paragraph is added to SECTION II - WHO IS AN INSURED, Paragraph 3: If you are engaged in the business of con- struction of dwellings three stories or less in height, or other buildings three stories or less in height and less than 25,000 square feet in area, you will also be an insured with respect to "your work" only, for the period of time described above, for your liability arising out of the conduct of any partnership or joint venture of which you are or were a member, even if that partnership or joint venture is not shown as a Named Insured. However, this provision only applies if you maintain or maintained an interest of at least fifty percent in that partnership or joint venture for the period of that partnership or joint venture. This provision does not apply to any partnership or joint venture that has been dissolved or otherwise ceased to function for more than thirty-six months. With respect to the insurance provided by this provision, Newly Formed or Acquired Organizations, the following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY, Paragraph 4. Other Insurance, Subparagraph b. Excess Insurance: The insurance provided by this provision, Newly Formed or Acquired Organizations, is excess over any other insurance available to the insured, whether primary, excess, contingent or on any other basis. (All other provisions of this section remain unchanged) Blanket Additional Insureds - As Required By Contract Subject to the Primary and Non -Contributory provision set forth in this endorsement, SECTION II - WHO IS AN INSURED is amended to include as an additional insured: A. Owners, Lessees or Contractors/Architects, Engineers and Surveyors 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy; and Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 9 INSUREW S COPY 2. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph 1. above: Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' caused, in whole or in part, by: a. Your acts or omissions; or b. The acts of omissions of those acting on your behalf; in the performance of your ongoing operations performed for the additional insured in Paragraph 1., above. However, this insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services by or for you, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifi- cations; and b. Supervisory, inspection, architectural or engineering activities. Professional services do not include services within construction means, methods, techniques, sequences and procedures employed by you in connection with your operations in your capacity as a construction contractor. A person or organization's status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. B. Other Additional Insureds Any of the following persons or organizations with whom you have agreed in a written contract, written agreement or written permit that such persons or organizations be added as an additional insured on your commercial general liability policy: 1. Lessors of Leased Equipment Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury", "property damage" or "per- sonal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. 2. Managers or Lessors of Premises Any person or organization from whom you lease premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you. This insurance does not apply to any "occur- rence" which takes place after you cease to be a tenant of that premises. 3. Mortgagees, Assignees or Receivers Any person or organization with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of your premises. This insurance does not apply to any "occurrence" which takes place after the mortgage is satisfied, or the assignment or receivership ends. 4. Any Person or Organization Other Than A Joint Venture Any person or organization (other than a joint venture of which you are a member), but only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts of omissions of those acting on your behalf in the performance of your ongoing operations or in connection with property owned by you. 5. State or Governmental Agency or Political Subdivision - Permits or Authorizations Any state or governmental agency or subdivision or political subdivision, but only with respect to: a. Operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization; or b. The following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: Copyright, 2018 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSURED'S COPY CG 73 00 01 19 Page 6 of 9 (1) The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; (2) The construction, erection or removal of elevators; or (3) The ownership, maintenance or use of any elevators covered by this insurance. This insurance does not apply to: (a) "Bodily injury' or "property damage" arising out of operations performed for the federal government, state or municipality; or (b) "Bodily injury" or "property damage" included within the "products - completed operations hazard". With respect to Paragraphs 2. through 4., this insurance does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. The provisions of this coverage extension do not apply unless the written contract or written agreement has been signed by the Named Insured or written permit issued prior to the "bodily injury' or "property damage" or "personal and advertising injury". Broad Form Vendors Coverage Subject to the Primary and Non -Contributory provision set forth in this endorsement, SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization (referred to below as vendor) for whom you have agreed in a written contract or written agreement to provide coverage as an additional insured under your policy. Such person or organization is an additional insured only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business. However, the insurance afforded the vendor does not apply to: a. "Bodily injury' or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement; however this exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; or f. Products which, after distribution or sale by you, have been labeled or re -labeled or used as a container, part of ingredient of any other thing or substance by or for the vendor; however this insurance does not apply to any insured person or organization, from who you have acquired such products, or any ingredient, part or container, entering into, accompanying or con- taining such products. The provisions of this coverage extension do not apply unless the written contract or written agreement has been signed by the Named Insured prior to the "bodily injury" or "property damage". Incidental Malpractice Subparagraph 2.a.(1)(d) under SECTION II - WHO IS AN INSURED is deleted in its entirety and replaced with the following: (d) Arising out of his or her providing or failing to provide professional health care services. This does not apply to nurses, emergency medical technicians or paramedics if you are not in the business or occupation of providing any such professional services. This also does not apply to "bodily injury" caused by cardio -pulmonary resuscitation or first aid services administered by a co -"employee". This provision does not apply if you are a Social Service or Senior Living risk. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS - Amendments Knowledge Of Occurrence, Claim, Suit Or Loss The following is added to Paragraph 2. Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: The requirements under this paragraph do not apply until after the "occurrence" or offense is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; Copyright, 2018 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSURED's COPY CG 73 00 01 19 Page 7 of 9 3. An "executive officer" or insurance manager, if you are a corporation; 4. Your members, managers or insurance manager, if you are a limited liability company; or 5. Your elected or appointed officials, officers, members, trustees, board members, commission members, agency members, or your administrator or your insurance manager if you are an organization other than a partnership, joint venture, or limited liability company. Primary and Non -Contributory Provision The following is added to Paragraph 4. Other Insur- ance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is primary to and we will not seek contribution from any other insurance available to an additional insured under this policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in a written contract, written agreement or written permit that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Unintentional Failure To Disclose Hazards The following is added to Paragraph 6. Representations under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: However, if you should unintentionally fail to disclose any existing hazards in your representations to us at the inception date of the policy, or during the policy period in connection with any additional hazards, we shall not deny coverage under this Coverage Part based upon such failure to disclose hazards. Waiver Of Transfer Of Rights Of Recovery The following is added to Paragraph 8. Transfer of Rights Of Recovery Against Others To Us under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: We will waive any right of recovery we may have against a person or organization because of payments we make for 'bodily injury' or "property damage" arising out of your ongoing operations or "your work" done under a written contract or written agreement and included in the "products -completed operations hazard", if: You have agreed to waive any right of recovery against that person or organization in a written contract or written agreement; 2. Such person or organization is an additional insured on your policy; or 3. You have assumed the liability of that person or organization in that same contract, and it is an "insured contract". The section above only applies to that person or organization identified above, and only if the "bodily injury" or "property damage" occurs subsequent to the execution of the written contract or written agreement. Liberalization The following condition is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: If we revise this Coverage Part to provide more coverage without additional premium charge, subject to our filed company rules, your policy will automatically provide the additional coverage as of the day the revision is effective in your state. Two or More Coverage Parts or Policies Issued By Us (This provision is not Applicable in the state of New York or W isconsin). The following condition is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: It is our intention that the various coverage parts or policies issued to you by us, or any company affiliated with us, do not provide any duplication or overlap of coverage. We have exercised diligence to draft our coverage parts and policies to reflect this intention. However, if the facts and circumstances that will respond to any claim or "suit" give rise to actual or claimed duplication or overlap of coverage between the various coverage parts or policies issued to you by us or any company affiliated with us, the limit of insurance under all such coverage parts or policies combined shall not exceed the highest applicable limit under this coverage, or any one of the other coverage forms or policies. This condition does not apply to any Excess or Umbrella policy issued by us specifically to apply as excess insurance over this coverage part or policy to which this coverage part is attached. SECTION V - DEFINITIONS Discrimination (This provision does not apply in New York). A. The following is added to Definition 14. "Personal and advertising injury': "Personal and advertising injury" also means "discrimination" that results in injury to the feelings or reputation of a natural person, however only if such "discrimination" or humiliation is: 1. Not done by or at the direction of: a. The insured; or Copyright, 2018 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSUREW S COPY CG 73 00 01 19 Page 8 of 9 b. Anyone considered an insured under b. Loss of, loss of use of, damage to, corruption of, SECTION II - WHO IS AN INSURED; inability to access, or inability to properly 2. Not done intentionally to cause harm to another manipulate "electronic data", resulting from person. physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at 3. Not directly or indirectly related to the em- the time of the "occurrence" that caused it. ployment, prospective employment or termi- nation nation of any person or persons For the purpose of the Electronic Data Liability coverage insured. by any n provided by this endorsement, "electronic data" is not tangible property. 4. Not arising out of any 'advertisement" by the insured. Employee Amendment B. The following definition is added to SECTION V - Definition 5. "Employee" under SECTION V- DEFINI- DEFINITIONS: TIONS is deleted in its entirety and replaced by the following: "Discrimination" means: 5. "Employee" includes a "leased worker", or a a. Any act or conduct that would be considered "temporary worker". If you are a School, "Employee" discrimination under any applicable federal, also includes a student teacher. state, or local statute, ordinance or law; Golfing Facility b. Any act or conduct that results in disparate The following definition is added to SECTION V - treatment of, or has disparate impact on, a DEFINITIONS: person, because of that person's race, religion, gender, sexual orientation, age, disability or "Golfing facility" means a golf course, golf club, driving physical impairment; or range, or miniature golf course. c. Any act or conduct characterized or interpreted Mental Anguish Amendment as discrimination by a person based on that (This provision does not apply in New York). person's race, religion, gender, sexual orienta- Definition 3. "Bodily injury under SECTION V - tion, age, disability or physical impairment. DEFINITIONS is deleted in its entirety and replaced with It does not include acts or conduct characterized or the following: interpreted as sexual intimidation or sexual harass- 3. "Bodily injury" means bodily injury, sickness or ment, or intimidation or harassment based on a disease sustained by a person, including death person's gender. resulting from any of these at any time. This includes Electronic Data mental anguish resulting from any bodily injury, The following definition is added to SECTION V - sickness or disease sustained by a person. (In New DEFINITIONS: York, mental anguish has been determined to be "Electronic data" means information, facts or programs "bodily injury"). stored as or on, created or used on, or transmitted to or Not-for-profit Member from computer software, including systems and The following definition is added to SECTION V - applications software, hard or floppy disks, CD-ROMS, DEFINITIONS: tapes, drives, cell, data processing devices or any other "Not-for-profit member' means a person who is a media which are used with electronically controlled member of a not-for-profit organization, including clubs equipment. For the purpose of the Electronic Data and churches, who receives no financial or other Liability coverage provided by this endorsement, "Property compensation. Definition 17. damage" is deleted in its entirety and replaced by the following: 17. "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 9 of 9 INSUREW S COPY PINNA COL ASSURANCE Western Consulting Company LLC 1685 S Colorado Blvd Denver. CO 80222-4036 ENDORSEMENT: Blanket Waiver of Subrogation 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com NCCI #: WC000313B Policy #: 4228876 CCIG 155 Inverness Drive West Englewood, CO 80112 (303)799-0110 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. Effective Date:March 1, 2022 Expires on: March 1, 2023 Pinnacol Assurance has issued this endorsement February 1, 2022 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P ROSSIGNB - Underwriter 02/01/2022 08:11:47 4228876 59296540 359-B OFFICIAL RESULTS REPORTS INTERNATIONAL F12 -National Standard Building r: CODE COUNCIL Contractor (B) Name: Benjamin Hauber Candidate ID: ICNON156233 Address: 1425 S Steele St. Date: 3/6/2020 Denver CO 80210 EXAMINATION RESULT: PASS Congratulations! You have passed the above-named examination. You will be able to verify your pass status on the ICC website within 48-72 business hours after your exam. Please contact your participating jurisdiction if you wish to pursue licensing. A passing score on this examination satisfies the testing requirements for licensure only, and does not guarantee that licensing will be granted. The candidate must also satisfy all local ordinance requirements in each jurisdiction where licensing is desired. It is extremely important that you notify Pearson VUE and ICC of any changes in name and/or address to avoid the possibility of future correspondence not being received. Please contact both Pearson VUE at 877-234-6082 and ICC at 888-422-7233 ext. 5524 with changes to your name and address. ICC reserves the right to amend or withhold any examination scores if, in its sole opinion, there is adequate reason to question their validity. The authenticity of this score report can be validated by using Pearson VUE's Online Score Report Authentication found at: www. PearsonVUE.com/authenticate Digital embossing eliminates the possibility of unauthorized embossing of counterfeit score reports. Registration Number: 370892369 . Validation Number': 757215231