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HomeMy WebLinkAboutDOHN CONSTRUCTION - INSURANCE CERTIFICATE (2)A�ORD CERTIFICATE OF LIABILITY INSURANCE OP ID R DOHNC-2 d DATE(MM/DDAODfY) 08 22 07 PRODUCER LBN Insurance Agency 4848 Thompson Pkwy Johnstown CO 80534 Phone 970-635-9400 Fax 970-635-9401 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 Dohn Construction, Inc 2642 Midpoint Drive Unit A Fort Collins CO 805�5 INSURER Employers Mutual INSURER Pinnacol Assurance INSURER INSURER 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 LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEYMMIDD/YYE PDATE M EXPIRATION LIMITS LIABILITY EACH OCCURRENCE $1,000,000 PREMISES(Ea omurence) $100,000 A COMMERCIAL GENERAL LIABILITY 1K57255 10/01/06 10/01/07 GGENERAL CLAIMS MADE50 OCCUR MED EXP(Any one person) $5,000 PERSONALSAOb 4JURY $1,000,000 Blanket Add'-' Ins X Blanket Waiver GENERAL AGGREGATE $2,000,000 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OPAGG s2,000,OOO PR POLICY X ECT LOC A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS 1Z57255 10/01 0 01/07 COMBINED SINGLE LIMIT (Edacudent) $ 1 OOO OOO r / X BODILY INJURY (Per person) $ X BODILY INJURY (PeracadenQ $ HIRED AUTOS NON OWNED AUTOS AUG 24 200 X PROPERTY DAMAGE (Perabodent) $ QF FORT COLLINS GARAGE LIABILITY RISK MANAGEMENT AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ ANY AUTO $ AUTO ONLY AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $5,000,000 A X OCCUR CLAIMS MADE 1J57255 10/01/06 10/01/07 AGGREGATE s5,000,000 8 $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR) -/EXECUTIVE 3055407 07/01/07 07/01/08 X TORV LIMITS ER BLEACH ACCIDENT I $1,000,000_ - - EL DISEASE EA EMPLOYEE $1,000,000 OFFICERIMEMBEREXCLUDE%CLUDED> It yes tlebLnba Under SPECIAL PROVISIONS below EL DISEASE -POLICY LIMIT $1,000,000 OTHER A Builders Risk 1I57255 10/01/06 10/01/07 One Loc $5,000,000 All Loc $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ALL OPERATIONS - ALL LOCATIONS CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 CITYOF7 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25 (2001108) © ACORD 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 4.]