HomeMy WebLinkAboutBOSCO CONSTRUCTORS INC - INSURANCE CERTIFICATEBOSCO-1 OP ID: ADR
Ali CERTIFICATE OF LIABILITY INSURANCE MEY
DATE
/11
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 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 endorsemen s . - - - - -
PRODUCER 303-996-7824
CONTACT
CRS/Surescape Ins. Services
6600 E. Hampden Ave.
Denver, CO 80224
Erik E. Ulibarri
PHONE 303-996-7800 FAX No:
ac No En:
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
- NAIC #
INSURER A: Westfield Insurance
INSURED Bosco Constructors, Inc.
6568 South Racine Cir
Centennial, CO 80111
INSURER 8:
INSURER C
INSURER D
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
EFF
MM/DDY/YYYY
UP
MM/
DDY YY
LIMITS
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE I OCCUR
TRA5002241
12101/11
12/01/12
EACH OCCURRENCE
$ 1,000,00
PREMISES Ea occurrence
$ 300,00
MED EXP (Any one person)
$ 10,00
PERSONAL B ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO- LOC
PRODUCTS - COMP/OP AGG
E_ 2,000,00
$ - -- '
A
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
X HIRED AUTOS X NON -OWNED
AUTOS
TRA5002241
12/01/11
12/01/12
-
CEaOMBINEDeccitlent SINGLE LIMIT
_ - 1,000,00
$
BODILY INJURY (Per person)
$
BODILY INJURY(Peraccident)
$
DAMAGE
nt
$
E
A
X
UMBRELLA LIAR
EXCESS UAB
X
OCCUR
CLAIMS -MADE
TRA5002241
12/01/11
12/01/12
URRENCE
$ 4,000,00
TE
$ 4,000,00
OED X RETENTION$ 0
AACCIDENT
$
WORKERS COMPENSATION
ANDEMPLOYERS'LIABIUTY Y/N
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory In NH)
It yes, Cesaibe underDESCRIPTION OF OPERATICNS below
N/A
STATU- OTH-
ACCIDENT
$
SE- EA EMPLOYEE
$
SE- POLICY LIMIT
$
A
Leased/Rented Eqp.
TRA6002241
12/01/11
12/01/12
Limit: 50,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space IS required)
RE: WaterNVastewater Treatment and Site Infrastructure, Design/Construction
Contractor #7220. All policy terms, conditions and exclusions apply.
City of Fort Collins, Financia
Services - Purchasing Division
215 N. Mason St., 2nd Floor, P
Ft. Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
�'k (., S o_Q,� ----
Otl 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD