HomeMy WebLinkAboutBOSCO CONSTRUCTORS INC - INSURANCE CERTIFICATE (3)BOSCO-1 OP ID: RAB
ll �M� CERTIFICATE OF LIABILITY INSURANCE
DATE 11114/201 YY)
1111412013
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 endorsements .
PRODUCER
CRS/Surescape Ins. Services
6600 E. Hampden Ave.
Denver, CO 80224
Erik E. Ulibarri
CONTACT
NAME:
PHONE FAX
INC. No Na:
EauIL
ADDRESS:
INSURER B AFFORDING COVERAGE
NAIC If
INSURER A : Valle orge Insurance Co.
INSURED Bosco Constructors, Inc.
INSURERS: Continental Casualty Co.
6568 South Racine Cir
Centennial, CO 80111
INSURER C: Pinnacol Assurance
INSURER D
NSURER 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
INI DfYYYY)
IMNUDDreYYY1
UNITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIM84AADE FKOCCUR
C5088584079
12101/2013
12/01/2014
EACH OCCURRENCE
$ 1,000,00
PREMISES Eaominarm
S 300,000
MEDEXP(Any onepanarl)
S 61
PERSONAL S ADV INJURY
S 1,000,00
X
PD Ded: $10,000
GENERAL AGGREGATE-
S $000,00
GENL AGGREGATE
POLICY
LIMIT APPLIES PER:
X PRO- LOC
PRODUCTS - COMP/OP AGO.
S 2,000,00
S
A
AUTOMOBILE L AMl
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIRED AUTOS X AUTOS
C5088584082
12101/2013
12/01/2014
COMBINED SINGLE LIMIT
Ea accldenl
1,000,00
BODILY INJURY (Par person)
S
BODILY INJURY IPer accident)
$
PROPERTY DAMAGE
PER AC IDEN
S
S
B
X
OYMBLLA LIAR
EXCESSLUB
X
OCCUR
CLAIMS -MADE
C5088684065
12/01/2013
12I01/2014
EACH OCCURRENCE
S 9,000,00
AGGREGATE
$ 9,000,00
DED X RETENTIONII 10,00
b
C
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN
OFFICERNEMSER EXCLUOED9
(Mandatory In NH)
DYea, e uncle,
DESCRIPTIORIPTION OF OPERATIONS oelow
NIA
2226180
04/01/2013
04/01/2014
X WCSTATU- OE
F.L. EADH ADDIDENT
a 500,00
E.L. DISEASE -EA EMPLOYEE
b 500,00
E.L. DISEASE -POLICY LIMIT
I S 500,00
A
Lease/Rented Equip
Spec Form/ACV
C6088584079
12/0112013
12/01/2014
Limits 350,00
Ded 1,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES lAfbaN ACORD 101, Addle ... I Remarks Sohedale, If,nore apaoe Is regalrad)
Re: Water/Wastewater Treatment and Site Infrastructure, Design/Construction
Contractor 07220. All policy terms, conditions and exclusions apply.
CFRTIFICATF HOI DER CANCELLATION
CITFTCO
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City Of Fort Collins
Financial Services
Purchasing Division
AUTHORGED REPRESENTATIVE
215 N Mason Street 2nd Floor,,,1
Ft. Collins CO 80522
C 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD