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Home My WebLink AboutDOHN CONSTRUCTION - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE HOP NC R DATE 6/11 YY7 DOHNC-2 06 11 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4848 Th Pk ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ompson wy Johnstown CO 80534 Phone:970-635-9400 Fax:970-635-9401 Dohn Construction, Inc 2642 Midpoint Drive Unit A Fort Collins CO 8M5 rnveoAr00 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Employers Mutual INSURER B: Pinnacol Assurance INSURER C: INSURER D: INSURER E. 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD/YV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurence) $100,000 A X COMMERCIAL GENERAL LIABILITY 1X57255 10/01/06 10/01/07 CLAIMS MADE FX-1 OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1 , 000 , 000 X Blanket Add r 1 Ins X Blanket Waiver GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 PRO LOG POLICY X ECT J A AUTOMOBILE LIABILITY ANY AUTO 1Z57255 10/01/06 10/01/07 COMBINED SINGLE LIMIT (Eaacadent) $ 1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 5 5,000,000 A X1 OCCUR F—ICLAIMSMADEJJ57255 10/01/06 10/01/07 AGGREGATE $5,000,000 $ DEDUCTIBLE PI $ 1 RETENTION $ WORKERS COMPENSATION AND X TORYTI 'M 1 T I ER B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 3055407 07/01/07 07/01/08 E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below - E.L. DISEASE -POLICY LIMIT $ 1 , 000 , 000 OTHER A Builders Risk 1157255 10/01/06 10/01/07 One Loc. $5,000,000 All Loc $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ALL OPERATIONS - ALL LOCATIONS CERTIFICATE HOLDER CANCELLATION CITYOF7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR PO BOX 580 REPRESENTATIVES. AU RIZE REPRES T Fort Collins, CO 80522-0580 AOORD 25 (2001108) W AGORD CORPORATION 1988 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 25 (2001/08)