HomeMy WebLinkAbout113752 BT CONSTRUCTION - INSURANCE CERTIFICATE (12)DATE (MMMDIYY)
ACORDN CERTIFICATE OF LIABILITY INSURANCE 1010112005 1 11/29/2004
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Lockton Companies ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
8110 E Union Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Suite 700 ALTER THE COVERAGE AFFORDED BY E P 1 IE L W.
Denver CO 80237 INSURERS AFFORDING COVERAGE
(303)414-6000
INSURED
1047338 BT Construction, Inc.
9885 Emporia Street
Henderson, CO 80640
COVERAGES 151LIVINU1 V U
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
7R
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDIYY
POLICY EXPIRATION
DATE MMIDD
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX ] OCCUR
KC08300263
10/03/2004
10/03/2005
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire
$ 300,000
MED EXP (Any one arson
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES
POUCV X I JEC X
PER:
LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
KC08300263
10/03/2004
10/03/2005
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per Person)
$ xxxxxxx
X
BODILY INJURY
(Per accident)
S J{XXXXxx
X
PROPERTY DAMAGE
(Per accident)
S XXXXXXX
GARAGE LIABILITY
ANY AUTO
I
NOT APPLICABLE
AUTO ONLY - EA ACCIDENT
$ XXXXXXX
OTHER THAN EA ACC
AUTO ONLY: AGG
$ XXXXYM
$ XXXXXXX
A
B
EXCESS LIABILITY
X OCCUR CLAIMS MADE
O UM
DEDUCTIBLE FORRMM
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
KC08300263
4023016
10/03/2004
10/01/2004
10/03/2005
10/01/2005
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
S XXXXXXX
XXXX7Q x
X WCSTATU- DTH-
S XXXXXXJC
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
City of Fort Collins
Attn: Purchasing
215 North Mason St.
Ft. Collins, CO 80524
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
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
AUTHORIZED REPRESENTATIVE
I
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