The URL can be used to link to this page

Home My WebLink AboutDON KEHN CONSTRUCTION - INSURANCE CERTIFICATE (2)unenw: Otclu nuUMAr"M ACORD. CERTIFICATE OF LIABILITY INSURANCE 05/03/07D/rivr) PRODUCER HRH of Colorado 720 South Colorado Boulevard Suite 60ON Denver, CO 80246 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Don Kahn Construction, Inc. 6650 SCR5 Fort Collins, CO 80528 INSURER A: Travelers Indemnity Company 25658 INSURER B: Travelers Property Casualty Company 36161 INSURER c. Pinnscol Assurance 10780 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. IN R NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE M /D POLICY EXPIRATION DATE MMID LIMITS A GENERAL LIABILITY 161E88931ND06 11/01/06 11/01/07 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY RA AGE TO RENTED $300 000 CLAIMS MADE 51 OCCUR MED EXP (Any one person) $5 000 PERSONAL 8 ADV INJURY $1 000 000 AI# CG D2 46 (08/05) GENERAL AGGREGATE s2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 17 POLICY X jECT 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 8 1 DILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS T X X PROPERTY DAMAGE (Per accident) $ Ltd Pollution GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESS/l1MBRELLA LIABILITY 161 E8893TIL06 11101/06 11101/07 EACH OCCURRENCE s2.000.000 X OCCUR CLAIMS MADE AGGREGATE s2 000 000 $ $ DEDUCTIBLE $ X RETENTION $ 10 000 C WORKERS COMPENSATION AND 2093950 10/01/06 10/01107 X WC STATU- 1 OTH- EMPLOYERS' LIABILITY ANY PROPRIETCRIPARTNERIEXECUTIVE E.L. EACH ACCIDENT s500 000 E.L. DISEASE - EA EMPLOYEE $500 000 OFFICER/MEMBER EXCLUDED? If yes describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT s500 OOO OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Project Description: 6045 Asphalt Supply The following are Additional Insureds as respects General Liability only if required by written contract and coverage applies only as respects (See Attached Descriptions) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Administrative Services NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL Purchasing Division IMPOSE NO OBLIGATION OR'LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR PO Box 580 REPRESENTATIVES. Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE ACSOKD Z5 (ZUU7/U9) 1 of 3 #S527561/M501113 8MSTY 0 ACORD CORPORATION 1983 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), authored representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon. ACORD 264S (2001/08) 2 of 3 f/S527561/M501113 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,l0 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 #S527561/M501113 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLIIrY, PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies.insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART 1, 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 addltional 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 exient that, the Injury or damage is cauaed by acts or omissions of you or your subcontractor In the performance of "youf'work" io 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 providedto the additional insured by this endorsement is limited as follows; a) in 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 insurance", the in- surance provided to the additional insured shell 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; i. 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 speciflcations; and il, Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional In- surod 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 addifional 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, S. The insurance provided to the additional insured; by this endorsement is excess river any valid and coiiectfble "other insurance", whether primary" excess, confingent or on any other, basis, that is :available to the aoditional insured .for a loss we- -`.cover under this endorsement, Howeveridf'ah& "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance Is primary to "other insurance" available to the additional insured which covert 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 t?asis, 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 MUS1 give us written notice as soon as prac::licable of an "occur- rence" or an offense which may result in a claim, To the extent possible, such notice should include: CG Q2 q6 08:0 .,x ;, 0 2005 The 3t-,:Pau1,Travelers Companies, Inc, -Page'" of 2 COMMERCIAL GENERAL LIABILITY 1. How, when and where the "occurrence" or offense took place; it, The'namas and addresses of any Injured persons and witnesses; and iii, The nature and location of any Injury or damage arising out of the "ocourrence" or offense. b) if a claim is made or "suit" is brought against the additional Insured, the additional insured must; 1.. Immediately record the spaclflos of the claim or "suit" and the date received; and 1L Notify us as soon as practicable, The additional insured must see to It that we receive written notice of the claim or "cult" as soon as practicable. o) , The additional Insured must Immediately send u$ copies of all legal papers recelved;it) connection with the claim or"Ouit", 000perato with us in the Investigation or settlement of the claim or defense against the "suit', and otherwise oomply with all policy conditions. d) The additional Insured must tender the de- fense and indemnity of any claim or aauit" to any provider of "other insurance" which would oover the additional Insured for a loss we cover under this endorsernenl, However, this condition doe$ not affect whether the Insur- anoe provided to the additional insured by this endorsement is primary to "other Insur. anoe" available to the additional hlsured which covers that person or organization as a named insured as described in paragraph 3, above, 6, The following definition Is added to SCCTION V, DEFINITIONS! "Written contract requiring insurance" moans that part of any written contract or agreement under which you are required to include a person or organization as an additional In- surad on this Covermge Part, provided that the "bodily injury" and "property damage" oc cure and the "personal Injury" It caused by an offense committed; a. After the signing and execution ci the contract or agreement by you; n, While that part of the contract or agreement is in effeot; and... c; Before the end of the pollcy .perlod. Page"2: of•52,as,.+rr+;n:,...-.<r+:,-•,,.0:2005.The:B,t:'Paut,.i'fraVolers Companles, Inc. r now saCts C72`4'$`0& a,