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HomeMy WebLinkAboutC16-402 Vail Honeywagon EnterprisesC16-402 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) 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 $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS 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 E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below 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 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 © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 1/31/2017 License # 0757776 (720) 207-2413 (866) 243-0727 13021 Vail Honeywagon Enterprises, LLC 955 Ute Creek Road Wolcott, CO 81655 28053 41190 19489 A 1,000,000 X X 60485230 01/01/2017 01/01/2018 100,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000A X X 60485230 01/01/2017 01/01/2018 2,000,000B FF01882700 01/01/2017 01/01/2018 2,000,000 0 C X 4133726 01/01/2017 01/01/2018 1,000,000 1,000,000 1,000,000 D Pollution Liability X 03105118 01/01/2017 01/01/2018 Incident/Aggregate 1,000,000 Eagle County, its associated or affiliated entities, its successors and assigns, elected officials, employees, agents and volunteers are additional insureds for General Liability, Automobile Liability and Pollution Liability. Eagle County, Colorado PO Box 850 Eagle, CO 81631 MOUNWAS-01 PVIANZON HUB International Insurance Services (COL) 1125 17th St Suite 900 Denver, CO 80202 Jessica Roscoe jessica.roscoe@hubinternational.com United Fire & Casualty Rockhill Insurance Pinnacol Assurance Company Allied World Assurance Co Inc X X X X X X X X Policy #60485230 Policy # 60485230 CA 71 09 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULL Y. BUSINESS AUTO ULTRA ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM COVERAGE INDEX Descriptio n Page TEMPORARY SUBSTITUTE AUTO PHYSICAL DAMAGE BROAD FORM INSURED EMPLOYEES AS INSUREDS ADDITIONAL INSURED STATUS BY CONTRACT, AGREEMENT OR PERMIT AMENDED FELLOW EMPLOYEE EXCLUSION TOWING AND LABOR PHYSICAL DAMAGE ADDITIONAL TRANSPORTATION EXPENSE COVERAGE EXTRA EXPENSE - THEFT RENTAL REIMBURSEMENT AND ADDITIONAL TRANSPORTATION EXPENSE PERSONAL EFFECTS COVERAGE AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE AIRBAG ACCIDENTAL DISCHARGE AUTO LOAN/LEASE TOTAL LOSS PROTECTION ENDORSEMENT GLASS REPAIR – DEDUCTIBLE AMENDMENT AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS WAIVER OF SUBROGATION REQUIRED BY CONTRACT UNINTENTIONAL FAILURE TO DISCLOSE HIRED, LEASED, RENTED OR BORROWED AUTO PHYSICAL DAMAGE EXTENDED CANCELLATION CONDITION 1 1 2 2 2 2 3 3 3 4 4 4 4 5 5 5 5 5 6 The COVERAGE INDEX set forth above is informational only and grants no coverage. Terms set forth in are likewise for information only and by themselves shall be deemed to grant no coverage. B. BROADENED LIABILITY COVERAGESA. TEMPORARY SUBSTITUTE AUTO PHYSICAL DAMAGE SECTION II – LIABILITY COVERAGE in Paragraph A. Coverage at 1. Who Is An Insured is amended to include the following: SECTION I – COVERED AUTOS , paragraph C. Certain Trailers, Mobile Equipment and Temporary Substitute Autos is amended by adding the following at the end of the existing language: d.Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of the Coverage Form. However, the Named Insured does not include any subsidiary that is an “insured” under any other automobile policy or would be an “insured” under such a policy but for its termination or the exhaustion of its Limit of Insurance. If Physical Damage Coverage is provided under 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 its breakdown, repair, servicing, “loss”, or destruction. CA 71 09 01 06 Includes Copyrighted material of Insurance Services Office, Inc., with its permission.Page 1 of 6 Policy #60485230 CA 71 09 01 06 e.Any organization that is acquired or formed by you, during the term of this policy and over which you maintain majority ownership. However, the Named Insured does not include any newly formed or acquired organization: C. AMENDED FELLOW EMPLOYEE EXCLUSION Only with respect to your “employees” who occupy positions which are supervisory in nature,SECTION II. LIABILITY B. Exclusion 5. Fellow Employee is replaced by:(1)That is a joint venture or partnership, 5. Fellow Employee(2)That is an “insured” under any other policy, “Bodily Injury”:(3)That has exhausted its Limit of Insurance under any other policy, or (a)To you, or your partners or members (if you are a partnership or joint venture), or to your members (if you are a limited liability company); (4)180 days or more after its acquisition or formation by you, unless you have given us notice of the acquisition or formation. (b)To your “executive officers” and directors (if you are an organization other than a partnership, joint venture, or limited liability company) but only with respect to performance of their duties as your officers or directors; Coverage does not apply to “bodily injury” or “property damage” that results from an accident that occurred before you formed or acquired the organization. (c)For which there is an obligation to share damages with or repay someone else who must pay damages because of the injury described in paragraph a and b above; or f.Any employee of yours while acting in the course of your business or your personal affairs while using a covered “auto” you do not own, hire or borrow. (d)Arising out of his or her providing or failing to provide professional health care services. g.Any person or organization whom you are required to add as an additional insured on this policy under a written contract or agreement; but the written contract or agreement must be: For purposes of this endorsement, a position is deemed to be supervisory in nature if that person performs principle work which is substantially different from that of his or her subordinates and has authority to hire, transfer, direct, discipline or discharge.(1)Currently in effect or becoming effective during the term of this policy; and D. BROADENED PHYSICAL DAMAGE COVERAGES (2)Executed prior to the “bodily injury” or “property damage”.SECTION III – PHYSICAL DAMAGE COVERAGE Coverage is amended as follows:The additional insured status will apply only with respect to your liability for “bodily injury” or “property damage” which may be imputed to that person(s) or organization(s) directly arising out of the ownership, maintenance or use of the covered “autos” at the location(s) designated, if any. 2. Towing and Labor We will pay towing and labor costs incurred, up to the limits shown below, each time a covered “auto” classified and rated as a private passenger type, “light truck” or “medium truck” is disabled: Coverage provided by this endorsement will not exceed the limits of liability required by the written contract or written agreement even if the limits of liability stated in the policy exceed those limits. This endorsement shall not increase the limits stated in Section II. C. Limits of Insurance. (a)For private passenger type vehicles or “light trucks” we will pay up to $75 per disablement. “Light trucks” have a gross vehicle weight (GVW) of 10,000 pounds or less.For any covered “auto” you own this Coverage Form provides primary coverage. CA 71 09 01 06 Includes Copyrighted material of Insurance Services Office, Inc., with its permission.Page 2 of 6 CA 71 09 01 06 (b)For “medium trucks” we will pay up to $150 per disablement. “Medium trucks” have a gross vehicle weight (GVW) of 10,001 lbs. to 20,000 pounds. (2)We will pay only for expenses incurred during the policy period and beginning 24 hours after the “loss” and ending, regardless of the policy's expiration, with the lesser of the following number of days: However, the labor must be performed at the place of disablement.(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, or4. Coverage Extensions (b)30 days.a. Transportation Expense is amended to provide the following limits:(3)Our payment is limited to the lesser of the following amounts:We will pay up to $50 per day to a maximum of $1,000. All other terms and provisions of this section remain applicable. (a)Necessary and actual expenses incurred; or (b)$35 per day. The following language is added to 4. Coverage Extensions:(c)This coverage does not apply while there are spare or reserve “autos” available to you for your operations.c. Theft Recovery Expense (d)If “loss” results from the total theft of a covered “auto” of the private passenger or light truck type, we will pay under this coverage only that amount of your rental reimbursement expense which is not already provided for under the SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, a. Transportation Expenses. If you have purchased Comprehensive Coverage on an “auto” that is stolen, we will pay the expense of returning that stolen auto to you. The limit for this coverage extension is $5,000. d. Rental Reimbursement We will provide Rental Reimbursement and Additional Expense coverage only for those Physical Damage coverages for which a premium is shown in the Declarations or schedule pages. Coverage applies only to a covered “auto” of the private passenger or light truck (10,000 lbs. or less gross vehicle weight) type for which Physical Damage coverages apply. ( e. Personal Effects If you have purchased Comprehensive Coverage on this policy for an “auto” you own and that “auto” is stolen, we will pay, without application of a deductible, up to $500 for Personal Effects stolen with the “auto”. The insurance provided under this provision is excess over any other collectible insurance. For this coverage extension, Personal Effects means tangible property that is worn or carried by an “insured”. Personal Effects does not include tools, jewelry, guns, musical instruments, money, or securities. (1)We will pay for auto rental expense and the expense incurred by you because of “loss” to remove and transfer your materials and equipment from a covered “auto” to a covered “auto.” Payment applies in addition to the otherwise applicable coverage you have on a covered “auto.” No deductible applies to this coverage. CA 71 09 01 06 Includes Copyrighted material of Insurance Services Office, Inc., with its permission.Page 3 of 6 CA 71 09 01 06 (4)With respect to this coverage, the most we will pay for all “loss” of audio, visual or data electronic equipment and any accessories used with this equipment as a result of any one “accident” is the lesser of:f. Audio, Visual and Data Electronic Equipment Coverage. (a)The actual cash value of the damaged or stolen property as of the time of the “loss”;We will pay for “loss” to any electronic equipment that receives or transmits audio, visual or data signals and that is not designed solely for the reproduction of sound. This coverage applies only if the equipment is permanently installed in a covered “auto” at the time of the “loss” or the equipment is removable from a housing unit which is permanently installed in a covered “auto” at the time of the “loss”, and such equipment is designed to be solely operated by use of the power from the ”auto's” electrical system, in or upon the covered “auto.” (b)The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality; or $1,000; minus a deductible of $100. An adjustment for depreciation and physical condition will be made in determining actual cash value at the time of loss. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. (1)We will pay with respect to a covered “auto” for “loss” to any accessories used with the electronic equipment described above. However, this does not include tapes, records or discs. If there is other coverage provided for audio, visual and data electronic equipment, the coverage provided herein is excess over any other collectible insurance. (2)In addition to the exclusions that apply to Physical Damage Coverage with exception of the exclusion relating to audio, visual and data electronic equipment, the following exclusions also apply: D. SECTION III – PHYSICAL DAMAGE COVERAGE, B. Exclusions is amended as follows: The following language is added to Exclusion 3.: If you have purchased Comprehensive or Collision Coverage under this policy, this exclusion does not apply to mechanical breakdown relating to the accidental discharge of an air bag. This coverage applies only to a covered auto you own and is excess of any other collectible insurance or warranty. No deductible applies to this coverage. (3)We will not pay for any electronic equipment or accessories used with such electronic equipment that are: (a)Necessary for the normal operation of the covered “auto” for the monitoring of the covered “auto's” operating system; or E. AUTO LOAN/LEASE TOTAL LOSS PROTECTION(b)Both: An integral part of the same unit housing any sound reproducing equipment designed solely for the reproducing of sound if the sound reproducing equipment is permanently installed in the covered “auto”; and SECTION III – PHYSICAL DAMAGE COVERAGE – C. Limit of Insurance is amended by adding the following language: 4.In the event of a total “loss” to a covered “auto” shown in the Schedule pages, subject at the time of the “loss” to a loan or lease, we will pay any unpaid amount due on the lease or loan for a covered “auto” less: Permanently installed in the opening of the dash or console normally used by the manufacturer for the installation of a radio. CA 71 09 01 06 Includes Copyrighted material of Insurance Services Office, Inc., with its permission.Page 4 of 6 CA 71 09 01 06 a.The amount paid under the Physical Damage Coverage Section of the policy; and (4)Your members, managers or insurance manager, if you are a limited liability company; orb.Any: (5)Your officials, trustees, board members or insurance manager, if you are a not-for-profit organization. (1)Overdue lease / loan payments at the time of the “loss’’; (2)Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; G. WAIVER OF SUBROGATION REQUIRED BY CONTRACT Under SECTION IV ,BUSINESS AUTO CONDITIONS, A. Loss Conditions 5. Transfer of Rights of Recovery Against Others to Us the following language is added: (3)Security deposits not returned by the lessor; (4)Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and However, we waive any rights of recovery we may have against the person or organization with whom you have agreed in writing in a contract, agreement or permit, to provide insurance such as is afforded under the policy to which this endorsement is attached. This provision does not apply unless the written contract or written agreement has been executed, or permit has been issued, prior to the “bodily injury” or “property damage.” (5)Carry-over balances from previous loans or leases. (GLASS REPAIR – DEDUCTIBLE AMENDMENT) Under D., Deductible is amended by adding the following: Any deductible shown in the Declarations as applicable to the covered “auto” will not apply to glass breakage if the damaged glass is repaired, rather than replaced. H. UNINTENTIONAL FAILURE TO DISCLOSE Under SECTION IV – BUSINESS AUTO CONDITIONS, Subsection B. General Conditions , the following is added to 2. Concealment, Misrepresentation Or Fraud :F. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Your unintentional error in disclosing, or failing to disclose, any material fact existing at the effective date of this Coverage Form, or during the policy period in connection with any additional hazards, will not prejudice your rights under this Coverage Form. Under SECTION IV – BUSINESS AUTO CONDITIONS, Subsection A., Loss Conditions , the following is added to paragraph 2. Duties In The Event of Accident, Suit or Loss: I. HIRED, LEASED, RENTED OR BORROWED AUTO PHYSICAL DAMAGE d.Knowledge of any “accident,” “claim,” “suit” or “loss” will be deemed knowledge by you when notice of such “accident,” “claim,” “suit” or “loss” has been received by: Under SECTION IV – BUSINESS AUTO CONDITIONS B. General Conditions 5. Other Insurance Paragraph 5.b.is replaced by the following:(1 ) You, if you are an individual; b. (1)For “Comprehensive” and “Collision” Auto Physical Damage provided by this endorsement, the following are deemed to be covered “autos” you own: (2)Any partner or insurance manager if you are a partnership; (3)An executive officer or insurance manager, if you are a corporation;(a)Any Covered “auto” you lease, hire, rent or borrow; and CA 71 09 01 06 Includes Copyrighted material of Insurance Services Office, Inc., with its permission .Page 5 of 6 CA 71 09 01 06 (b)Any Covered “auto” hired or rented by your “employee” under a contract in that individual “employee's” name, with your permission, while performing duties related to the conduct of your business. (3)This Hired Auto Physical Damage coverage is excess over any other collectible insurance. (4)Definitions For This Section (a)Comprehensive Coverage: from any cause except the covered “auto's” collision with another object or the covered “auto's” overturn. We will pay glass breakage, “loss” caused by hitting a bird or animal and, “loss” caused by falling objects or missiles. However, any “auto” that is leased, hired, rented or borrowed with a driver is not a covered “auto” (2)Limit of Insurance For This Section The most we will pay for any one “loss” is the lesser of the following:(b)Collision Coverage: caused by the covered “auto's” collision with another object or by the covered “auto's” overturn. (a)$50,000 per accident, or (b)actual cash value at the time of loss, or J. EXTENDED CANCELLATI ON CONDITION (c)cost of repair.A.Under CANCELLATION,of the COMMON POLICY CONDITIONS form, item 2.b . is replaced by the following:minus a $500 deductible. An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total loss. No deductible applies to “loss” caused by fire or lightning. b.60 days before the effective date of cancellation if we cancel for any other reason CA 71 09 01 06 Includes Copyrighted material of Insurance Services Office, Inc., with its permission .Page 6 of 6 7501 E Lowry Blvd Denver, CO 80230-7006 303-361-4000 / 800-873-7242 www.pinnacol.com Mountain Roll Offs Inc ETAL Attn: Karen Berens 10100 E 102nd Ave Henderson, CO 80640 Hub International Insurance Service 1125 17th Street Ste. 900 Denver, CO 80202-4364 (888) 795-0300 7501 E Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P ISA -01/03/2017 18:43:25 4133726 48155462 359-B NCCI #: WC000313B Policy #: 4133726 ENDORSEMENT:Blanket Waiver of Subrogation Effective Date: January 1, 2017 Expires on: January 1, 2018 Pinnacol Assurance has issued this endorsement January 3, 2017. Diversified Center of Excellence Phone (303) 361-4300 / (877) 361-4300 Fax (303) 361-5300 / (888) 329-2208 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.