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BARTRAN CONSTRUCTION INC - INSURANCE CERTIFICATE
OP ID: CT ,4 --- CERTIFICATE OF LIABILITY INSURANCE �� DATE/14/2015 ovlanols 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 Phone: 970-223-1804 VolkBell Properly 8 Casualty 1100 Haxton Dr. uite #100 Fax: Fort Collins, CO 80525 Steven G. Smith CONTACT PHONE FA% No ac Ne : E-MAIL ADDRESS: PRODUCER gARTR-2 CUSTOMER ION: INSURER(S) AFFORDING COVERAGE NAICp INSURED Bartran Construction, Inc. INSURER A: Builders Insurance Group Dan Bartran P.O. Box 270855 Ft. Collins, CO 80527-0855 INsuRER a : Pinnacol Assurance 41190 INSURERC:Secura Insurance Companies 22543 INSURER D: Zurich North America INSURR E NSUREER 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. INBR LTR TYPE OF INSURANCE DL SUBR POLICY NUMBER PMIDOYEFF MMIDDIPOLICYY XP YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GLP0116858 12/2712014 1212712015 PREMISES Ea occurrff ence $ . 100,000 MED EXP(My me pmam) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,OD X POLICY IRO - $ C AUTOMOBILE AUTOMOBILE LIABILITY ANYAUTO A3145376 12127I2014 12I27I201$ COMBINED SINGLE LIMIT (Ea acddenU $ 1,000,00 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per aoddent) S X X C C SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per aWdent) $ X $ C NON-OWNEO AUTOS E UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE s 1,000,00 A EXCESS LIAB CLAIMS -MADE UMB0117090 12/2712014 12127/2015 DEDUCTIBLE $ $ RETENTION $ 10,000 B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERRAEMBER EXCLUDED? (Mandatory In NH) NIA 413622D DZID112D14 D2ID112D1$ WCSTATU- OTH- X TORY IMITG ER E.L. EACH ACCIDENT $ 500,00 El. DISEASE EA EMPLOYE S 500,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 C Egiup Fit' CP3145375 12127I2013 1212712015 Lsd 8 Rnt 25,00 D Builders Risk BR68317726 O1I16I2014 01I16I2015 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddlUonal Remark; Schedule, Ii mare apace le nquired Cit of Fort Collins is named as additional insured as required by writ en conTract. FTCOL-1 City of Fort Collins 970-224-6134 Attn:Sandy P.O. Box 580 Fort Collins, CO 80522-0580 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 ©1988.2009 ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD