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HomeMy WebLinkAbout113752 BT CONSTRUCTION - INSURANCE CERTIFICATE (22)ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 On /2018 101 /2017 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 endorsement(s). PRODUCER Lockton Companies 8110 E Union Avenue Suite 700 Denver CO 80237 CONT NAME: PHONE FAX A/C No Ext : AIC No): E-MAIL ADDRESS: INSURER 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 BTrenehless, Inc. 9885 Emporia Street INSURER C : Travelers Property Casualty Cc of America 25674 Henderson, CO 80640 INSURER D : INSURER E: INSURER F : COVERAGES BTCONOI 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 SUER WVD POLICY NUMBER POLICY EFF 1MMfDDfYYYY POLICY EXP 1MM1DDfYYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y N DTC041H983410PHX 10/l/2017 10/l/2018 EACH OCCURRENCE 1,000,000 PREMISES (E. oNcurrOence 300,000 MED EXP (Any oneperson) 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY jR O- X❑ LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 21000,000 1 $ B AUTOMOBILE LIABILITY ANY AUTO OWNEDAUTOS ONLY SAUTOSCHEDULE[) AUTOS ONLY X AUTOS ONLY WNED Y N D'178104H98341000F 10/l/2017 10/l/2018 Ea aBINEDtSINGLE LIMIT $ 11000,000 X BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXX X Perr. denROPERTY t DAMAGE $ XXXXXXX $ XXXXXXX C X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE N N 1 CUP-8J518965-17-26 1 10/1/2017 10/l/2018 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED I I RETENTION $ $ XXXXXXX C WORKERS COMPENSATION AND EMPLOERS'LIABILIITY YIN ANY OFFICER/HEM ER/EXCLUDED? EXECUTIVE N❑ (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N / A N UH-6J84757A-17-26-G 10/1/2017 I 10/1/2018 I X STATUTE DER E L. EACH ACCIDENT �1 $ 1 000000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space 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 AUTHORIZED REPRESENTATIVE City of Ft. Collins PO Box 580 Ft. Collins CO 80522 t� C ACORD 25 (2016/031 ©1 8 201! ORP17111CATI171N. All riahts reserved The ACORD name and logo are registered marks of ACORD A(;UHIJ, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/l/2019 1 10/1/2017 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 endorsement(s). PRODUCER Lockton Companies CONTACT 8110 E Union Avenue Suite 700 Denver CO 80237 A/C No Ext : A!C Na E-MAIL ADDRESS: INSURER(S)A AFFORDING COVERAGE N IC s (303) 414-6000 INSURER A: The Phoenix Insurance Company 25623 INSURED BT Construction, Inc. 1312924 9885 Emporia Street Henderson, CO 80640 wsURER B : The Charter Oak Fire Insurance Company 25615 Travelers Property Casualty Co of America INSURER c : P y y 25674 INSURER D : INSURER E : INSURER F : COVERAGES BTCONOI CERTIFICATE Nt1MRFR- 141'M74 P9=VIQInkl IUIIUQr_0- vvvvvYY THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD 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 SUER VWD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP (MM/DDfYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY Y N DTC04H983410PHX 10/1/2017 10/1/2018 EACH OCCURRENCE 1,000,000 CLAIMS -MADE � OCCUR PREMISETO S (Ea RENTED 300,000 MED EXP (Any oneperson) 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PE 0 [XILOC GENERAL AGGREGATE $ 2,000 000 PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER. B AUTOMOBILE LIABILITY Y N DT8104H98341000F 10/1/2017 10/1/2018 COMBINED SINGLE LIMIT Ea accident)$ 1,000,000 X BODILY INJURY (Per person) $ XXXXXXX ANY AUTO AWNED UTOS ONLY AUTOSULED BODILY INJURY (Per accident $ XXXXXXX AUTOS ONLY X AUUTOS ONLYY X PROPERTY DAMAGE Per accident $XXXXXXX $XXXXXXX C X UMBRELLA LIAR I X OCCUR Y N CUP-8J518965-17-26 10/1/2017 10/1/2018 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ XXXXXXX C WORKERS COMPENSATION AND EMPLOERS'LABILIITY Y/N N UB-6J84757A-17-26-G 10/1/2017 10/1/2018 X STATUTE I JOETRH- E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/EXCLUDR/EXECUTIVE � OF EXCLUDED? (Mandatory in If yes, describe antlnd under DESCRIPTION OF OPERATIONS below N / A E.L. DISEASE - EA EMPLOYEE 1 -000 000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 63984 - Fossil Creek/BNSF Pedestrian 'funnel. The City of Fort Collins is included as Additional Insured as respects General, Auto, and Umbrella Liability as required by written contract. v�r\ r rrrv� r nv�a.r�re %.A1VlrGLLA I IUIV ,)eC Attacnments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14121074 AUTHORIZED REPRESENTATIVE The City of Fort Collins, Colorado 4316 LaPorte Avenue Fort Collins, CO 80522 ACORD 25 (2016103) ©1 8 2015 ACORD CORPO ATION. All rinhts rpsprvpri The ACORD name and logo are registered marks of ACORD AGORD,M CERTIFICATE OF LIABILITY INSURANCE 10/1/2018 DATE(MM/DD/YYYY) 10/ 1 /2017 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 endorsement(s). PRODUCER Lockton Companies 8110 E Union Avenue Suite 700 Denver CO 80237 CONTACT NA hi A/C No Ext : FAX No): E-MAIL ADDRESS: INSURER AFFORDING COVERAGE N IC # (303) 414-6000 INSURER A: The Phoenix Insurance Company 25623 INSURED BT Construction, Inc. 1312924 9885 Emporia Street Henderson, CO 80640 INSURER B : The Charter Oak Fire Insurance Company 25615 INSURER C : Travelers Property Casualty Co of America 25674 INSURER D : INSURER E : INSURER F : COVERAGES 13TCON01 CERTIFICATE NUMBER: 14060423 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/D /YYYY POLICY EXP (MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y N DTC04H983410PHX 10/1/2017 10/1/2018 EACH OCCURRENCE 1,000,000 PREMISES (ETO a RENTED ) $ 300,000 MED EXP (Any oneperson)5 OOO PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY PE� Fx LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO AWNED SC UTOS ONLY AUTOSULED HIRED NON -OWED X AUTOS ONLY AUTOS ONLY Y N DT8104H98341000F 10/1/2017 10/1/2018 COMBINED SINGLE LIMIT Ea accident $ 1 OOO OOO X BODILY INJURY (Per person) $ XXXXXXX I BODILY INJURY (Per accident $ XXXXXXX X PRPE PeOacctl YtDAMAGE $ XXXXXXX $XXXXXXX C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N CUP-8J518965-17-26 10/1/2017 10/1/2018 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DEC) I I RETENTION $ $ XXXXXXX C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ER EXCLUDED? N OFFICER/MEMB❑ (Mandatory in NH) it yes, describe under DESCRIPTION OF OPERATIONS below NIA N UB-6J84757A-17-26-G 10/1/2017 10/1/2018 X STATUTE R E .L. EACH ACCIDENT $ 1 000 000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Mich) an 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 �Qr/e/� I�r ACORD 25 (2016/03) 08812015 ACORD CORPO ATION. All rights reserved The ACORD name and logo are registered marks of ACORD