HomeMy WebLinkAbout113752 BT CONSTRUCTION - INSURANCE CERTIFICATE (5)ACORD. CERTIFICATE OF LIABILITY INSURANCE
10/01/2006
06/29/2006
PRODUCER
Lockton Companies
8110 E Union Avenue
Suite 700
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 POLICIES BELOW,
Denver CO 80237
(303) 414$000
INSURERS AFFORDING COVERAGE
INSURED
1047338 BT Construction, Inc.
Attn: Michelle Ciancio
INSURER Travelers Pr . Casualty
INSURER B : Pinnacol Assurance
INSURER C,
9885 Emporia Street
Henderson, CO 80640
INSURER D,
COVERAGES BTCON01 VLJ N IS CE TI ICAA
TH R ZED NSURANPCE D ESANOV ONSE ORPTIITUTE RODUCER A CONTRACT BETWEEN THE I UINC
AND THE CERTIFICATE HOLDER
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
TR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDD
POLICY EXPIRATION
DATE (MMIDDIYYI
LIMITS
A
GENERAL LL481LITY
X COMMERCIAL GENERAL LIABILITY
DTC00605C718IND05
10/03/2005
10/03/2006
EACH OCCURRENCE
$ 1000 000
FIRE DAMAGE (Any one fire
$ 300,000
MED EXP (Any onePerson)
$ 5,000
CLAIMS MADE O OCCUR
PERSONAL 6 ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE
X POLICY
LIMIT APPLIES
JPER& X
PER:
LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
DT8100605C718TIL05
2
`�
�fr/
�/0 ^1j1j�Q} j1/1
DtSINGLE LIMIT
(Ea
$ 1,000,000
X
BODILY INJURY
(Per person)
$ XXXXXXX
ALL OWNED AUTOS
SCHEDULED AUTOS
1.5.l1�
HIRED AUTOS
NON -OWNED AUTOS
tl i�
2006
X
BODILY INJURY
(Per accident)
S XXXXXXX
X
ITY
OF FOR
I COLLINS
RISK MANAGEMENT
PROPERTY DAMAGE
(Per accident)
S xxXxxxX
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$ XXY—NXXX
OTHER THAN EA ACC
AUTOONLY: AGG
S XXXXXXX
ANY AUTO
I
NOT APPLICABLE
$ XXXXXXX
A
EXCESS LIABILITY
X I OCCUR F1 CLAIMS MADE
DTSMCUP0605C718TIL05
10/03/2005
10/03/2006
EACH OCCURRENCE
$ 1,000 000
AGGREGATE
$ 1,000,000
$ XXXXX) x
xUMBRELLA
XX)CK)M
DEDUCTIBLE FORM
RETENTION S
S XXi�X, XXX
B
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
4023016
10/01/2005
10/01/2006
X IWC STATU-
TO
E.L. EACH ACCIDENT
$ 100,000
E.L. DISEASE - EA EMPLOYEES
100 000
E.L. DISEASE - POLICY LIMIT
1 $ 500,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: Bobcat Ridge Access Latimer County Road 32C Improvements. The City of Fort Collins and Anderson Consulting Engineers are included as Additional
Insureds with respects to General Liability.
EIRTIFICATE HOLDER
X
I ADDITIONAL INSURED• INSURER LETTER: ANCELLATION
2610151
City of Fort Collins
P.O. Box 580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Fort Collins, CO 80522
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
A5-a trier) .orye..n.n.rw.mmami...dm.a.,e.eta tt namb.rawdInte.'Pmdewr"CUM .Ew..nd.pwifyth..rr.ntood.'aTCONer' QACORD CORPORATION 1988