HomeMy WebLinkAboutBOSCO CONSTRUCTORS INC - INSURANCE CERTIFICATE (4)BOSCO-1 OP 1D: RAB
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CERTIFICATE OF LIABILITY INSURANCE D1
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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
PRODUCER
CRS/Surescape Ins. Services
5600 E. Hampden Ave.
Denver, CO 80224
Erik E. Ulibarn
INSURED. i Bosco Constructors, Inc.
6568 South Racine Cir
Centennial, CO 80111
Pinnacol
Con
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
MILDI W�YYFYY
XP
MPMN� IYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FXI OCCUR
CSM584079
12/0112013
12/01/2014
EACH OCCURRENCE
$ 1,000,00
PREMISES (Ea xammq
$ 300,0111111
MED EXP (Any one n
S 15,00
PERSONAL S AOV INJURY
S 1,000,00
X
PD Ded: $10.000
GENERAL AGGREGATE
IS 2,000,0011
GEN'L AGGREGATE LIMIT APPLIES PER:
1-1 POLICY X PRO- LOC
PRODUCTS-COMP/OP AGG
f 2,000,00
$
A
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULEDBODILY
AlnOS AUTOS
NON-0WNEO
HIRED AUTOS X AUTOS
Ix
C50685940B2
12J01=3
17101/i014
BOMINED SINGLE LIMIT
Ea aINED
1,000,00
BODILYINJURY(Pwpenon)
S
INJURY(PW SCCideM)
S
PROPERTY DAMAGE
PER ACCIDENTI
S
$
B
X
UMeR6LALNa
EXCESSUAe
X
OCCUR
culMs-I4AOE
C5088584065
12/01/2013
12MI12014
EACH OCCURRENCE
f 9,000.00
AGGREGATE
5 9,000,00
DED X RETENTION 10,00
f
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/El(ECUTNEYIN
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
No deacdbe under
DESCRIPTION OF OPERATIONS below
NIA
2226180
04l01/2014
0410VA15
X WCSTATU- OTH-
TI
EA_ EACH ACCIDENT
f 500,0
E.L. DISEASE - EA EMPLOYEES
500,00
E. L. DISEASE - POLICY LIMIT
S 500,00
A
Rent/Lease Equip
Special FOrmIACN
C5068584079
12/01/2013
12101/2014
Each Max 25,00
Ded 1,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ARmh ACORD 101, AMdlsonal Remarks Schedule, If mon aPSde IS r W nXl)
Re: Water/Wastewater Treatment and Site Infrastructure, Design/Construction
Contractor #7220. All policy terms, conditions and exclusions apply.
City of Fort Collins
Financial Services
Purchasing Division
215 N Mason Street 2nd Floor
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.
AUTHORUDEO REPRESENTATIVE
Q 1
V 1955-ZUIU AL.UKU L.UKYURA I IUK. All ngnu mbelveu.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD