HomeMy WebLinkAbout113752 BT CONSTRUCTION - INSURANCE CERTIFICATE (17)ACORD, CERTIFICATE OF LIABILITY INSURANCE
1o;uzo2o
DATE (MM/
9/12/201 9YY)
019
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(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
(303)414-6000
CONTACT
NAM
A/C No):
A/C No Ex): (A/C,
E-MAIL
ADDRE
GE
INSURER A: The Phoenix Insurance Corrivany
25623
INSURED BT Construction, Inc.
1112924 9885 Emporia Street
Henderson, CO 80W
INSURER B: T—I— Propcny Cudahy Cc ofAmenca
25674
INSURER C:
INSURER
INSURER E,
INSURER F :
CCVERAPCC RTrr)Xl 11 CLRTIFICATF NIIuRFR• 19QQA1d7 RFVISICIN NIIMRFR- 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.
�R
LT
TYPE OF INSURANCE
ADOL
SUBR
POLICY NUMBER
P ICOY FF
P I Y
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 0 OCCUR
Y
N
DT-CO-411983410-PHX-19
10/1/2019
10/1/2020
EACH OCCURRENCE
1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence)
3OO OOO
MED EXP (Any oneperson)
5,000
PERSONAL & ADV INJURY
$ 1000 000
GEML AGGREGATE LIMIT APPLIES PER:
POLICY JEa LOG
OTHER:
GENERAL AGGREGATE
s 2,000,000
PRODUCTS - COMP/OP AGG
s 2,000,000
$
B
AUTOMOBILE
LIABLLITY
ANY AUTO
AUTOS ONLY AUTOSULED
AUTOS ONLY X AUTOS ONLY
Y
N
810-tN339174-19-26 G
IO/I/2019
]0/1/2020
COMBINED SINGLE LIMIT
Eaccident)
$ 1 000 000
BODILY INJURY (Per person)
S XXXXXXX
BODILY INJURY (Per accident
$ xxxxxxx
Ix
(Per accident) PROPERTY DAMAGE
$ XX XXXX
$xXxxxxXX
13
}(
UMBRELLAUAB
EXCESS LIAR
1 }(
OCCUR
CLAIMS -MADE
Y
N
CUP-81518965-19-26
10/1/2019
10/1/2020
EACH OCCURRENCE
$ 10000000
AGGREGATE
$ 10 000 000-
DIED I I RETENTION $
S XX)3IXXX
B
WORKERS COMPENSATION
AND EMPLOYERVLUBILITY YIN
ANY PROPRIETOWPARTNEWEXECUTIVE
OFFtCERW1EMBER EXCLUDE01 EE (Myandatory In NH)
If OESCRIPT�tee under ION OF OPERATIONS below
N / A
N
UB-6J84757A-19-26-G
10/1/2019
]0/1/2020
X srATurE I I OETIR
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE- EA EMPLOYEE
1000 000
E.L. DISEASE- POLICY LIMB
1 �00 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mom apace is required)
RE: 64047 - Moore Lane Sewer Improvements Project. The City of Fort Collins is included as Additional Insured as respects General, Auto, and Umbrella
Liability as required by written contract.
L.t t< l IHUA It MULUtil
OCC flll41:1111 .[ it
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
15996147
AUTHORIZED REPRESENTATIVE
The City of Fort Collins, Colorado
4316 LaPorte Avenue
Fort Collins, CO 80522
ACORD 25 (2016/03) 1988-20115 ACORO CORP RATION. All rights reserved
The ACORD name and logo are registered marks of ACORD