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HomeMy WebLinkAbout113752 BT CONSTRUCTION - INSURANCE CERTIFICATE (16)ACORD, CERTIFICATE OF LIABILITY INSURANCE 10/1/2020 DATE""'"IDONYM 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 certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 endomement(s). PRODUCER Lockton Companies 8110 E Union Avenue Suite 700 Denver CO 80237 (303)414-6000AFFORDING CONTACT AM it FAX A/C No Ext : NC No), E-MAIL ADDRES& INSURER A: The Phoenix Insurance Company 25623 INSURED BT Construction, Inc. 1312924 9885 Emporia Street Henderson, CO 80640 INSURER B: Travelers Property Canilty Co of America 25674 NSURER c: INSURER 0, INSURER E , INSURER COVERAGES RTCON01 CERTIFICATE NLIMRER- 14060423 REVISION NLIMRER- 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. INSR T TYPE OF INSURANCE ADDL Jm SUBR JmPOLICY NUMBER POLICY EFF MM POLICY EXP D LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y N DT-CO-4H9834I0-PHX-19 10/1/2019 101 /2020 EACH OCCURRENCE 1,000,000 RNTED PREMISES CIE ToEaEccunenns 300,000 MED EXP (Any one arson 5,000 PERSONAL B ADV INJURY $ 1000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JPER6 � LOC OTHER: GENERAL AGGREGATE s 2,000 000 PRODUCTS - COMP/OP AGG S 2 000 000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY X NON-OWNED ONLYY Y N 810-6N339174-19-26-G 10/1/2019 10/1/2020 COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) S }I;X}{XX}fJ{ BODILY INJURY (Per accident S XX!,)�� X DAMAGE S XXX)CXXX $J{xxxx Qt R ){ UMBRELLALUB EXCESS LIAR X OCCUR CLAIMS -MADE N N CUP-8J518965-19-26 10/1/2019 10/1/2020 EACH OCCURRENCE $ 10,000,000 AGGREGATE S 10,000,000 DED I I RETENTION $ $XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS'LIABILTTY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERAIEMSER EXCLUOED9 � Ireandrda in Will Ir Yes de ee u,Mer DESCRIPTION OF OPERATIONS oel. N I A N UB-6J84757A-19-26-G 10/l/2019 10/1/2020 PER OTH. X STATUTE I ER E.L. EACH ACCIDENT $ 1000000 E.L.DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT t 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more apace Is required) RE: Michigan Ditch Tunnel - 8106 Utility Infrastructure Construction Services for Water, Wastewater and Stormwater Facilities Capital Improvements. The City of Fort Collins is included as Additional Insured as respects General Liability and Auto Liability as required by written contract. 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. 14060423 AUTHORIZED REPRESENTATIVE City of Fort Collins 4316 LaPorte Avenue Fort Collins, CO 80522 _c ACORD 25 (2016/03) ©1988-20 5 ACORO CORP RATION. All rights reserved The ACORD name and logo are registered marks of ACORD