HomeMy WebLinkAbout113752 BT CONSTRUCTION - INSURANCE CERTIFICATE (4)ACORD.M CERTIFICATE OF LIABILITY INSURANCE 10/01/2007
ATE (MMIDD/YY
09/26/20061
PRODUCER Lockton Companies
P
8110 E Union Avenue
Suite 700
Denver CO80237
(303)414 -6000
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLI. IES BELOW.
INSURERS AFFORDING COVERAGE
INSURED
1047338 BT Construction, Inc.
9885 Emporia Street
Henderson, CO 80640
INSURERA: Travelers Prop. Casualty
INSURER B : Pinnacol Assurance
�INSIJBERC
INSURER D
INSURER E
CAVFRAr,FS RTrnTant VTT
THI5 CERTIFICATE OF IN5UKANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING
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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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDIYY
POLICY EXPIRATION
DATE MMIDDIYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx-1 OCCUR
DTC00605C718IND06
10/03/2006
10/03/2007
EACH OCCURRENCE
1,000,000
FIRE DAMAGE (Any one fire
$ 300,000
IVIED EXP (Any oneperson)
$ $ 000
PERSONAL & ADV INJURY
$ 1,000,000
GENERALAGGREGATE
2,000,000
GEN'L AGGREGATE LIMIT APPLIES
POLICY Fxl JEOT X
PER:
LOG
PRODUCTS - COMP/OP AGG
$ 2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
DT8100605C718TIL06
10/03/2006
10/03/2007
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$ XXXXXXX
X
BODILY INJURY
(Per accident)
$ XXXXXXX
X
PROPERTY DAMAGE
(Per accident)
$ XXXXXXX
GARAGE LIABILITY
ANY AUTO
NOT APPLICABLE
AUTO ONLY - EA ACCIDENT
$ XXXXXXX
OTHER THAN EA ACC
AUTO ONLY: AGG
XXXXXXX
XXXXXXX
A
EXCESS LIABILITY
X OCCUR 7 CLAIMS MADE
xUMBRELLA
DEDUCTIBLE FORM
RETENTION $
DTSMCUP0605C718TIL06
10/03/2006
10/03/2007
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
XXXXXXX
XXXXXXX
$ XXXXXXX
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4023016
10/01/2006
10/01/2007
X TO WC Y LIMIT OTH-
E.L. EACH ACCIDENT
$ 100,000
E.L. DISEASE - EA EMPLOYEE
$ 100,000
E.L. DISEASE - POLICY LIMIT
$ 500,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: City of Fort Collins Contract No. P951. City of Fort Collins is included as Additional Insured as respects General Liability.
2146488 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Attn: Purchasing
215 North Mason St. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
Ft. Collins, CO 80524 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25-S (7/97) For questions regarding thiscsrtigcste,contactthenumberlist"inthe•Produmesectionabowend&"citytheclientcode'BTCON01•. 1)ACORDCORPORATION1999