HomeMy WebLinkAbout113752 BT CONSTRUCTION - INSURANCE CERTIFICATE (9)ACORD. CERTIFICATE OF LIABILITY INSURANCE 10/1/2011
DATE (MM/DD/YYYY)
9/29/2010
PRODUCER Lockton Companies, LLC Denver
8110 E Union Avenue
Suite 700
Denver CO 80237
(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 POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED BT Construction, Inc.
1047338 9885 Emporia Street
Henderson, CO 80640
INSURER A: The Travelers Indemnity Company
25658
INSURER B: Travelers Property Casualty Co of America
25674
INSURER c : Pinnacol Assurance Company
41190
INSURER D
INSURER E :
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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
LTR
ADDT
INSRD
-
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS -
GENERAL LIABILITY -
EACH OCCURRENCE
$ 1,000,000
PREMGE TO a oocurence
$ 300,000
A
X COMMERCIAL GENERAL LIABILITY
DT-CO-0605C718-IND-10
10/3/2010
- 10/3/201 1
CLAIMS MADE a OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2000,000
FGIN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2 000 000
PRO -
POLICY X JECT X LOC
B
AUTOMOBILE LIABILITY
X ANY AUTO
DT-810-0605C718-TIL-10
10/3/2010
10/3/2011
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per person)
$ XXXXXXX
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$ XXXXXXX
X HIRED AUTOS
X NON -OWNED AUTOS
-
PROPERTY DAMAGE
(Per accident)
$ XXXXXXX
GARAGE LIABILITY
-
AUTO ONLY - EA ACCIDENT
$ XXXXXXX
ANY AUTO
NOT APPLICABLE
OTHER THAN EA ACC
$ XXXXXXX
$ XXXXXXX
AUTO ONLY: AGG
B
EXCESS/UMBRELLA LIABILITY
X OCCUR CLAIMS MADE
DTSM-CUP-0605C718-TIL-10
10/3/2010
10/3/201 L
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
$ XXXXXXX
UMBRELLA
El
$ XXXXXXX
DEDUCTIBLE X FORM
$ XXXXXXX
RETENTION $
C
WORKERS COMPENSATION AND
4023016
10/l/2010
10/l/2011
X WC STATU- OTH-
TO ER
FlyEMPLOYERS'
LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
FN
E.L. EACH ACCIDENT
$ 100,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$ 100,000
If yes, describe under
SPECIAL PROVISIONS below
-
E.L. DISEASE - POLICY LIMIT
e
$ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: City of Fort Collins Contract No. P951. City of Fort Collins is included as Additional Insured as respects General Liability.
CERTIFICATE HOLDER
CANCELLATION
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
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
215 North Mason St.
Ft. Collins, CO 80524
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
_
I
ACORD 25 12009/011
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1 88-2009 ACORD CO ORATION. All riahts reserved
The ACORD name and logo are registered marks of ACORD
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Fnr ni—tinnc mnardinthie rertifirah, cnntact the number lis ed in the'Prn user' certinn ahnve and cnerifv the client rntle'RTCON01'-