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HomeMy WebLinkAboutDCI RESIDENTIAL LLC DOHN CONSTRUCTION INC - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID RC DOHNC-2 DATE(MM/DDmY) 06 16 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance Agcy-Johnstown 4848 Thompson Pkwy, Ste 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 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 INSURERB: Pinnacol Assurance 41190 Dohn Construction Inc. DCI Residential, LLC INSURER C: INSURERD: 2642 Midpoint Drive Unit A Fort Collins CO 80515 INSURER E: rnvcoer_Gc 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 DATEYMM DD/YY EFFECTIVE PDA EY MM/DD/YY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 ED- PREMISES (Ea occurence) $ 100,000 A X COMMERCIAL GENERAL LIABILITY 1D57255 10/01/08 10/01/09 MED EXP (Any one person) $ 5,000 CLAIMS MADE 1*1 OCCUR PERSONAL & ADV INJURY $1,000,000 X Blanket Add'1 Ins GL FORM CG0001 12/04 X Blanket Waiver GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X PROECT LOC J A AUTOMOBILE LIABILITY ANY AUTO 1Z57255 10/01/08 10/01/09 COMBINED SINGLE LIMIT (Ea accident) $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 $ 10,000,000 A X I OCCUR CLAIMS MADE 1J57255 10/01/08 10/01/09 AGGREGATE $ 10,000,000 $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND X TORY LIMITS I I ER B EMPLOYERS' LIABILITY _ [ANY PROPRIETOR/PARTNER/EXECUTIVE OFFiCERii iEIri=R XCLUDED? - -- _ 3055407 07/01/09 07/01/10 E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000 If yes, describe under SPECIAL PROVISIONS below E.L. D!SEP.SE - POLICY LIMIT . $ 1 , 000 , 000 OTHER A Builders Risk 1X57255 10/01/08 10/01/09 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. Fort Collins, CO 80522-0580 AUT II�DiIE�RESE��IVE'�ww uIw d/MAl/ ACORD 25 (2001/08) © 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. O ACORD 25 (2001/08)