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HomeMy WebLinkAboutDOHN CONSTRUCTION - INSURANCE CERTIFICATE (3)A(MR-P. CERTIFICATE OF LIABILITY INSURANCE OF ID RC DATE(MM/DDIVYVY) DOHNC-2 06 16 08 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 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Johnstown CO 80534 Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Employers Mutual INSURERD Pinnacol Assurance -- -__ ..__.. __ - Do n Construction Inc ---- DCI. INSURERC 264 Residential Drive __. ._....._......._. Fort Midpoint O 805 Unit A INSURERD: Fort Collins CO 80515 -------.- -- _._. INSURER E: LR!1lgEClK]�7 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. INS DD' _... __ —__. ___ __ POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDOM' DATE MM/DD/YV T LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [Xj OCCUR 1D57255 10/01/07 10/01/08 PREMISESBaoccurence) s3.00,000 RED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $1,000,000 X Blanket Add'1_Ins GL FORM CG0001 12/04 XJBlanke_t Waiver - GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG s2,000,000 POLICY X PRO- JECT LOC - A AUTOMOBILE LIABILITY ANYAUTO 1Z57255 10/01/07 10/01/08 COMBINED SINGLE LIMIT accident) $ 1 000 r ,QQQ X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) X ----- PROPERTY DAMAGE (Per accident)$ ----------- GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC ---. $ ANY AUTO— -- $ AUTO ONLY: AGO A EXCESS/UMBRELLA LIABILITY X-1 OCCUR FICLAIMSMADE 1J57255 10/01/07 10/01/08 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? uritlr--CIALPROVISDN$beloW 3055407 07/01/0$ 07/01/09 X TORV LIMITS ER --"L EA ----R E.L. EA CH ACCIDENT --- $1, QQQ,QQQ _ E.L. DISEASE - EA EMPLOYEE .... $ 1,000,000 F:.L. DISEASE -POLICY LIMIT$QQQ,QOQ ERilders JA Risk 1I57255 10/01/07 10/01/0 OOne Loc. $5,000,000 All Loc $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ALL OPERATIONS - ALL LOCATIONS City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001108) 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. 25 ACORD CERTIFICATE OF LIABILITY INSURANCE OF ID RC I DATE(MM/DD/YYYY) DOHNC-2 1 06 16 08 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 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Johnstown CO 80534 Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Emplovers Mutual INSURER 8'. Pi. nnacol Dohn Construction Inc. ___------ DCI Residential, LLC INSURERC. -URER D 2642 Midpoint Drive Unit A INSURER D: Fort Collins CO 80525 -- ----- 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 'OD' NSR TYPE OF INSURANCE -- POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION-- DATE MM/DD/YY - -- LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 000 , 000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE L.I OCCUR 1D57255 10/01/07 10/01/08 AMAGE PREMISE, CREN , (Eaoccurence) .-___....... —- $ 100,000 MED EXP (Any one person) s5,000 X Blanket Add I 1 Ins PERSONAL &ADV INJURY $ 1 , 000 , 000 Blanket Waiver GENERAL AGGREGATE $2,000,000 GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG - $2,000,000 POLICY X JECT LOC ----'_. A AUTOMOBILE LIABILITY ANY AUTO 1Z57255 10/01/07 10/01/08 COMBINED SINGLE LIMIT (Ea accident) g1 OOO OOO r r X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ ANY AUTO ---- OTHER THAN EA ACC $ $ AUTO ONLY: AGO EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $5,000,000 A X OCCUR 1-1 CLAIMSMADE 1J57255 10/01/07 10/01/08 AGGREGATE $5,000,000 $ DEDUCTIBLE RETENTION It $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY— ANY PROPRIETOR/PARTNER/EXECUTIVE 3055407 07/01/08 07/01/09 X TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000, DOD OFFICER/MEMBER EXCLUDED? yes, describe antler DISEASEPOLICY E.L. DISEASE -POLICY LIMIT 1 $1 OOO, DDD S SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ALL OPERATIONS - ALL LOCATIONS CITYOF3 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 $O SHALL City of Fort Collins Attn: Sandy IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR PO BOX 580 REPRESENTATIVES. Fort Collins, CO 80522 AUT I*AEjRESEffATIV ._ , ACORD 25 (2001108) ©ACORD CORPORATION 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.