HomeMy WebLinkAboutDOHN CONSTRUCTION - INSURANCE CERTIFICATE (5)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID R DATE(MWDDNYYY)
DOHNC-2 06 18 03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Linden/Bartels S Noe Agency FC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1614 Oakridge Drive, Unit A I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80525
Phone:970-229-9304 Fax:970-229-1398
Dohn Construction, Inc
2642 Midpoint Drive Unit A
Fort Collins CO 80M5
Vwv&R wCJ
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Employers Mutual
INSURERB: Pinnacol Assurance
INSURER C:
INSURER D:
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.
NUIR
LTR
Ai
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE (MM1D
DATE MWDD EXPIRATION
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1 , OOO , OOO
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X� OCCUR
IKS725503
10/01/02
10/01/03
PREMISES (Ea occurence)
$100,000
MED EXP (Any one person)
$ 5 , 000
PERSONAL &ADV INJURY
$ 1 , 000 , 000
GENERAL AGGREGATE
$ 2., 000 / 000
KENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$2,000,000
POLICY PRO-
JECT LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
1Z5725503
10/01/02
10/01/03
(Ea accident) COMBINED SINGLE LIMIT
$ 1 000 00
X
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
HIRED AUTOS
NON-OWNEDAUTOS
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
S
GARAGE
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
THAN EA ACC
AUTO ONLY: AGG
$
$
A
EXCESSIUMBRELLA LIABILITY
X I OCCUR EICLAIMSMADE
1JS725503
10/01/02
10/01/03
EACH OCCURRENCE
$ 5 , OOO , OOO
AGGREGATE
$5,000,000
$
DEDUCTIBLE
RETENTION $
$
B
B
WORKERS COMPENSATION AND
EMPLOYERS• LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
S yes,deacnbeunder
SPECIAL PROVISIONS below
3055407
3055407
07/01/02
07/01/03
07/01/03
07/01/04
JOTF
X TORY LIMITS ER
E.L. EACH ACCIDENT
$100,000
E.L. DISEASE - EA EMPLOYE
$100,000
E.L. DISEASE -POLICY LIMIT
r
$,,00 000
OTHER
A
Builders Risk
1F5725503
10/01/02
10/01/03
1 LOC. $5,000,000
ALL LOC. $5000000
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS
RE: Fire Station Expansion and Renovation Projects. The City of Fort Collins
is named as additional insured in respects to the General Liability.
CITYOFF 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, BIIT FAILURE TO DO SO SHALL
Purchasinty g
ing Division Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY R, ITS AGENTS OR
Purc
PO BOX 580 REPRESENTATIVES.
Ft Collins CO 80522-0580 AUTHORIZED REPRESENTATIVE
Michael D. Pierce