HomeMy WebLinkAbout113752 BT CONSTRUCTION - INSURANCE CERTIFICATE (21)ACORD, CERTIFICATE OF LIABILITY INSURANCE
10/1/2016
DATE(MM/DD/YYYY)
9/28/2015
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 endorsement(s).
PRODUCER Lockton Companies
8110 E Union Avenue
Suite 700
Denver CO 80237
NAME:
PHONE
AIc No Ext : Arc, No):
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
(303) 414-6000
INSURER A: The Phoenix Insurance Company
25623
INSURED BT Construction, Inc.
INSURER B : The Charter Oak Fire Insurance Company
25615
1312924 BTrenchless, Inc.
9885 Emporia Street
INSURER C : Travelers Property Casualty Co of America
15674
Henderson, CO 80640
INSURER D :
INSURER E :
INSURER F :
COVERAGES BTC0N0l CERTIFICATE NUMBER: 13656740 REVISION NUMBER: 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
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
(MM/DDNYYY1
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
Y
N
DTC03G208946PHX
10/3/2015
10/1/2016
EACH OCCURRENCE
1,000,000
PREMISES (Ea RENTED
)
$ 300,000
MED EXP (Any oneperson)
5,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRCOT- a LOC
OTHER
GENERAL AGGREGATE
$ 2,000 000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
AUTOWNED AUTOS
NON OWNED
HIRED AUTOS X AUTOS(Pero
Y
N
8103G208946COF
10/3/2015
10/1/2016
(COaocid DtSINGLE LIMIT
$ 1,000 000
BODILY INJURY (Per person)
$ XXXXXXX
Ix
BODILY INJURY (Per accident
$ }{}{}(}(XXX
PRPERTY DAMAGE
accident
$ XXXXXXX
$XXXXXXX
C
X
UMBRELLA LIAB
EXCESS LIAB
NCLAIMS-MADE
OCCUR
N
N
DTSMCUP3G208946TIL
10/3/2015
10/1/2016
EACH OCCURRENCE
$ 10000000
AGGREGATE
$ 10,000,000
DED I I RETENTION $
$ }{j{}(j{XXX
WORKERS COMPENSATION
AND EMPLOYERS' LABILIITY YIN
ANY
OFFICER/MEMBER ER EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVEFN
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
N
DTJUB3G250386
10/1/2015
10/1/2016
'ERC
X STATUTE FIR
E.L. EACH ACCIDENT
$ 11000000
E.L. DISEASE - EA EMPLOYEE
l 000 000
E.L. DISEASE - POLICY LIMIT
1 1.000.000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: 8106 Utility Infrastructure Construction Services for Water, Wastewater and Stonnwater Facilities Capital Improvements. Additional Insured: City
of Ft. Collins, its officers, agents and employees.
CERTIFICATE HOLDER CANCELLATION
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 AUTHORIZED REPRESENTATIVE
City of Ft. Collins
PO Box 580
Ft. Collins CO 80522
ACORD 25 (2014/011 0)1 8 2014 ACORD CORPO ATION_ All rinints reserved
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