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Home My WebLink AboutDON KEHN CONSTRUCTION - INSURANCE CERTIFICATErrPinirir S2210 BDONKEHN ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MMID 10/30/06 DIYYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH of Colorado 720 South Colorado Boulevard ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 60ON Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIC # INSURED Don Kehn Construction, Inc. INSURER ATravelers Indemnity Company 36161 INSURER B: Travelers Property Casualty Company 10780 6550 SCR5 Fort Collins, CO 80528 INSURER C: Pinnacol Assurance INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADDTPOLICY INSRE TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE MMIDDIY POLICY EXPIRATION DATE (MMIDDIYYI LIMITS A GENERAL LIABILITY 161EB893IND06 11/01/06 11/01/07 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 5x] OCCUR DAMAGE TO RENTED PREMISES a ccrrence $300000 MED EXP (Any one Person) $5 000 PERSONAL & ADV INJURY $1,000,000 AI# CG D2 46 (08/05) GENERALAGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2000000 POLICY 7X PROJECT X LOC B AUTOMOBILE LIABILITY ANY AUTO 161E8893TIL06 11/01/06 11/01/07 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X X PROPERTY DAMAGE (Per accident) $ Ltd Pollution GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESSIUMBRELLA LIABILITY 161 E8893TIL06 11/01/06 11/01/07 EACH OCCURRENCE s2,000,000 X OCCUR 7 CLAIMS MADE AGGREGATE s2,000,000 $ $ DEDUCTIBLE FX1 $ RETENTION $ 1O 000 C WORKERS COMPENSATION AND 2093950 10/01/06 10/01/07 X WC SLIMT OTH- EE- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT s5OO OOO E.L. DISEASE - EA EMPLOYEE $500000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Project Description:Bid 5958 East Prospect Road Improvements The following are Additional Insureds as respects General Liability only if required by written contract and coverage applies only as respects (See Attached Descriptions) City of Fort Collins 215 North Mason Street, 2nd Floor PO Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE At-UKU Z9 WZDVI/GG) 1 of 3 #M500897 8TBEC 0 AGORD CORPORATION 19UH IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25S (2001/08) 2 of 3 #M500897 DESCRIPTIONS (Continued from Page 1) work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. Additional Insureds:City of Fort Collins The Additional Insured endorsement which is referenced above under "Type of Insurance -General Liability" is attached. * The following cancellation conditions always apply: -10 days for non-payment of premium - If policy shown,10 days for Workers' Compensation for fraud; material misrepresentation; non-payment of premium; other reasons approved by the Commissioner of Insurance AMS 25.3 (2001/08) 3 of 3 #M500897 COMMERCIAL GENERAL LIABILITY THIS I✓NDORGEMPNT CHANGES THE POLICY, PLEASE READ iT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies.insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED — (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) if, and only to the extent that, the Injury or damage is caused by acts or omisslons of you or your subcontractor In the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the Independent acts or omissions of such person or organization. 2, The Insurance provided to the additional insured by this endorsement Is limited as follows; a) to the event that the Limits of Insurance of this Coverage Part shown In the Declarations exceed .the limits of liability required by the "written contract requiring insuranoe", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance", This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of insurance. b) The Insurance provided to the additional in- sured does not apply to "bodily injury", "prop, erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: The preparing, approving, or failing to Prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and it, Supervisory, inspection, architectural or engineering activities. c) The Insurance provided to the additional In- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products -completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional Insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier, The insuranc6 provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance", whether primary, excess, contingent or on, any other basis, that is available to the additional insured for a loss we cover under this endorsement, However, If the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-oontributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible 'other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such 'other insur- ance". a, As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must givo us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include; CC D2 45 08 05 02005 The St, Paul Travelers Companies, Inc, Pagel of 2 COMMERCIAL GEN5-RAL LIABILITY I, How, when and where the "occurrence" or offense took place; 11, The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrenoe" or offense, b) If a claim is made or "suit' is brought against the additional insured, the additional insured must I. Immediately record the specifics of the claim or "suit' and the date received; and IL Notify us as soon as practicable. The additional Insured must see to It that we receive written notice of the claim or "suit" as soon as practicable, c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit"., and otherwise comply With all policy conditions. d) The additional Insured must tender the de- fense and indemnity of any claim or "auit" to any provider of "other Insurance" which would covor the additional Insured for a loss we cover under this endorsarrient. However, this condition does not affect whether the Insur- ance provided to the additional insured by this endorsement is primary to 'other insur• ance" available to the additional insured which covers that person or organizatlon as a named insured as described in paragraph 3. above, S. The following definition is added to SECTION V, W DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b, While that pert of the contract or agreement is in effect; and c. Before the end of the policy period, I Page 2 of 2 9 2005 The St, Paul Travelers Companies, Inc. CG ❑2 46 oB 05 The INA Financial Group, Inc. INA of Colorado, Inc. 1550 17th Street Suite 600 Denver, CO 80202 City of Fort Collins, Colorado 215 North Mason Street, 2nd Floor PO Box 580 Fort Collins, CO 80522 USA USA If you have questions regarding the content of this document, please contact the Producer/Agent listed on the certificate of insurance. cc: The data included in this notice and in the attached document is confidential to ConfirmNet and the party responsible for bringing you this information. Powered SyCertiticalesNowTM