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HomeMy WebLinkAbout113752 BT CONSTRUCTION - INSURANCE CERTIFICATE (14)ACORD,. CERTIFICATE OF LIABILITY INSURANCE l0,-1/2ozo DA9/121/ 0YY11) /1?./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: N the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. if SUBROGATION IS WANED, subject to the terms and conditlons 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 endursement(s). PRODUCER Lockton Companies 8110 E Union Avenue .Suite 700 Denver CO 80237 (303)414-6000 CONTACT NAM i FAX A/C Ext : A/C No E-MAIL AD R INSURERfSI AFFORDINGCOVERAGE INSURER A; The Phoenix Insurance Company 25623 INSURED BT Construction, Inc. 1312924 9885 Emporia Street Henderson. CO 80640 INSURER B: Travelere Property Caxuahy Co of America 25674 INSURER C : INSUR R D INSURER E : INSURER F; COVERAGES RTCnN01 CERTIFICATE NIIMRFR: 16077420 RFVISION Ni1MRFR• XXXXXXX 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. ILTR TYPE OF INSURANCE ADDL �� POLICY NUMBER MM�DDVt Erb MM/DDY P LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEOOCCUR Y N DT-CO-4H983410-PHX-19 10/1/2019 10/1/2020 EACH OCCURRENCE 1. 1 000000 DAMAGE EaENTErren 300000 MED EXP (Any oneperson) 5,000 PERSONAL. & ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYN]JEa OLOC OTHER: GENERAL AGGREGATE s 2,000,000 PRODUCTS - COMP/OP AGG S2000000 S B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY X AUTOS NEONLY Y N 810-6N339174-19-26-G l0/1/2019 10/1/2020 COMBINED SINGLE LIMIT i 1,000,000 BODILY INJURY (Per person) $ 7(j(j(3C)= Ix BODILY INJURY (Per accident S X PPROPERTY DAMAGE S XXXXXXX S XX7(3(XXX B }( UMBRELLALIAB EXCESS LIAR }( OCCUR CLAIMS -MADE Y N CUP-8J519%5-19-26 10/1/2019 10/1/2020 EACH OCCURRENCE $ 10000000 AGGREGATE $1 O O(M) �00 DED RETENTION 8 $ XXJ(}(XXX B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OF ICERMEIMBER EXCLUDED? ECUTIVE � (Myandatary In NR) If as. PTION OF OPERATIONS W. N / A N UB-6J84757A-19-26-G 10/1/20t9 10/1/2020 PER OTH- X STATUTE E.L. EACH ACCIDENT ^^ $ 1 000 000 EL. DISEASE - EA EMPLOYEE 1 000 000 E.L. DISEASE -POLICY LIMn 1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remark* Sched=, may be attached if mom space Is required) RE: 8106 Utility Infrastructure Construction Services. City of Fort Collins is included as additional insured with respects to General Liability, Automobile Liability, and Excess Liability as required by written contract. VCRI iriIL iC r1VLVer[ L.AV MLLAIIVPI acefttacnmen[s SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16077420 AUTHORIZED REPRESENTATIVE City of Fort Collins Financial Services Purchasing Division N. Mason St. 2nd Floor, PO Box 80522 For Collins CO 80522 Fort ACORD 25 (2016/03) ©1988-20 5 ACORD CORP RATION. All rights reserved The ACORD name and logo are registered marks of ACORD