HomeMy WebLinkAboutBT CONSTRUCTION INC - INSURANCE CERTIFICATEACORD, CERTIFICATE OF LIABILITY INSURANCE
o/112ozo
DATE (MM2019YY)
9/12/2019
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 certifleate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WANED, 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 endorsement(s).
PRODUCER Lockton Companies
8110 E Union Avenue
Suite 700
Denver CO 80237
N
A/C, No Ert : A/C No):
E-MAIL
s R s AFFORDING COVERAGE
(303) 414-6000
INSURER A: The Phoenix Insurance Company
25623
INSURED BTConstruction. Inc.
1312924 BTrenchless, Inc.
9885 Emporia Street
INSURERB: Trawler; Property Cmty Co of America
25674
INSURER C :
Henderson, CO 80640
sUR
INSURER E :
INSURERF:
rnvcoer_cc ATf I"'IMA'1 rcnTlatrATr-uI Iunco- I lf,"7dr1 aculainu ul wneo. YYYYYYY
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.
INTR
TYPE OF INSURANCE
IN D
WVD SUER
POLICY NUMBER
POLICY
Epp EFF
POLICMM/DDY ExP
LIMITS
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
Y
N
DT-CO-41`1983410-PHX-19
10/1/2019
10/1/2020
EACH OCCURRENCE
1,000,000
PREMISES EE TO RENTED,
occu enCa
300,000
MED EXP (Any oneperson)
5,000
PERSONAL ti ADV INJURY
S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY O JE a 7 LOC
OTHER:
GENERAL AGGREGATE
9 2 000 000
PRODUCTS - COMPIOP AGG
$ 2,000,000
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
ONLY AUTOSULED
ONLY X AUTOOSWONLY
y
N\
310-CN339174-19-26-Ci
10/1/2019
10/1/2020
COMBINED SINGLE LIMIT
S 1,000,000
BODILY INJURY (Per person)
S 2{XX)C}{]{7{AUWTOS
Ix
(�ii{X�{i{i{i{BODILY INJURY Par accident
SAUTOS
PROPERTYDAMAGEDAMAGE er accidentl
$ J{J{XXXX {
13
}{
UMBRELLA UAB
EXCESS LIAB
j
OCCUR
CLAIMS -MADE
N
N
CUP-8I518965-19-26
10/1/2019
10/1/2020
EACH OCCURRENCE
E 10000000
AGGREGATE
S IO O0O OOO
DED RETENTION $
5 ){J{J{}{ym
H
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANV PROPRI ETORIPARTNER/EXECUTIVE
OFFICERaAEMSER EXCLUDED?
(1111"sssduory In NH)
If
DMRVION OF OPERATIONS W.
NIA
N
UB-6J84757A-19-26-G
10/1/2019
10/1/2020
PER OTH-
X STATUTE R
E.L. EACH ACCIDENT
$ 1000 000
E.L. DISEASE - EA EMPLOYEE
1,000,000
E.L. DISEASE -POLICY LIMIT
Is 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mom apace Is required)
RE: 8106 Utility Infrastructure Construction Services for Water, Wastewater and Stormwater Facilities Capital Improvements. Additional Insured: City
of Ft. Collins, its officers, agents and employees.
CERTIFICATE HOLDER CANCELLATION See Attachments
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
13656740
City of Ft. Collins
PO Box 580
Ft. Collins CO 80522
ACORD 25 f2016/031 n1988-2015 ACORN CORP6RATION_ All rights reserved
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