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Home My WebLink About102829 DON KEHN CONSTRUCTION INC - INSURANCE CERTIFICATE (5)Client#: 51160 DONKEI ACORDT, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/29/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Flood & Peterson Ins., Inc. Corporate Mailing Address: P. O. Box 578 CONTACT NAME: Dana M Stewart ONE FA X X/C No Ext : 970 266 7149 A1C, No : 970 506 6845 E-MAIL SS: dana.stewart@fpinsurance.com Greeley, CO 80632 CUSTOMER ID If, INSURER(S) AFFORDING COVERAGE NAIC N INSURED Don Kehn Construction, Inc. 6550 S. County Road 5 Fort Collins, CO 80528 INSURER A: The Cincinnati Insurance Compan INSURER B : INSURER C INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL UBR pOLICV NUMBER MM/DD/YYYV EFF OLICY EXP PMM/DD/YYVY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 5_1 OCCUR X PD Ded:2,500 X X CPP1804111 11/01/2010 11/01/2011 EACH OCCURRENCE $1 000 000 DAMAGE To RENTED PREMISES (E. occurrence) $300 000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOCI PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car I CPP1804111 11/01/2010 11/01/2011 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ X $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPP1804111 11/01/2010 11/01/2011 EACH OCCURRENCE s3,000,000 AGGREGATE s3,000,000 DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU- I OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Project Description: Renewal, 6045 Asphalt Supply The following are Additional Insureds as respects General Liability only if required by written contract (See Attached Descriptions) I=1:PI1119Ja. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Division PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S571532/M571510 DXS DESCRIPTIONS (Continued from Page 1) and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. Additional Insureds: City of Fort Collins. This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract. AMS 25.3 (2009/09) 2 Of 2 #S571532/M571510 Client#: 51160 DONKEI ACORDn., CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/29/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Flood & Peterson Ins., Inc. Corporate Mailing Address: P. O. Box 578 CONTACT NAME: Dana M Stewart ONE g70 266 7149 FAx P970 506 6845 /C No El : A/C, No AMDRE ADDRESS: dana.stewart@fpinsurance.com PRODUCER Greeley, CO 80632 CUSTOMER ID If: INSURER(S) AFFORDING COVERAGE NAIC If INSURED INSURER A: The Cincinnati Insurance Compan Don Kehn Construction, Inc. 6550 S. County Road 5 Fort Collins, CO 80528 INSURER B INSURER C INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRPOLICY TYPE OF INSURANCE DDL BR NUMBER POLICY EFF MWDD/YYYY POLICY EXP MWDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx� OCCUR X PD Ded:2,500 X X CPP1804111 11/01/2010 11/01/2011 EACH OCCURRENCE $1 000 000 DA AGE To PREM SES a oN Ecur ante $300 000 IVIED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car CPP1804111 11/01/2010 11/01/2011 COMBINED SINGLE LIMIT (Ea accident) $1000000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ X $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPP1804111 11/01/2010 11/01/2011 EACH OCCURRENCE s3,000,000 AGGREGATE s3,000,000 DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below WA WC STATU- OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project Description: Furnishing Asphalt The following are Additional Insureds as respects General Liability only if required by written contract (See Attached Descriptions) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Director of Puchasing & Risk Management PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522-0580 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S571534/M571510 DXS DESCRIPTIONS (Continued from Page 1) and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. Additional Insureds: City of Fort Collins. This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract. AMS 25.3 (2009/09) 2 of 2 #S571534/M571510 Client#: 51160 DONKEI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY) 10/29/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Flood & Peterson Ins., Inc. Corporate Mailing Address: P. O. Box 578 CONTACT NAME: Dana M Stewart NE PHO970 266 7149 FAX 970 506 6845 A/C No Ext : A/C, No): E-MAIL dana.stewart@fpinsurance.com Greeley, CO 80632 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: The Cincinnati Insurance Compan Don Kehn Construction, Inc. 6550 S. County Road 5 Fort Collins, CO 80528 INSURER B INSURER C INSURER D INSURER E : INSURER F : __COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS- TYPE OF INSURANCE DDL UBR POLICY NUMBER MM/DD/VYYV IMMIX 1YVYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR X PD Ded:2,500 X X CPP1804111 11/01/2010 11/01/2011 EACH OCCURRENCE $1 000 000 DAMAGE TO RENTED PREMISES (Ea occurrence) s300,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car CPP1804111 11/01/2010 11/01/2011 COMBINED SINGLE LIMIT (Ea accident) $11000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ X $ A X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE CPP1804111 11/01/2010 11/01/2011 EACH OCCURRENCE s3,000,000 AGGREGATE s3,000,000 DEDUCTIBLE RETENTION $ $ _WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEa OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below WA WC STATU- I OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project Description: 6045 Asphalt Supply The following are Additional Insureds as respects General Liability only if required by written contract (See Attached Descriptions) City of Fort Collins Administrative Services Purchasing Division PO Box 580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S571535/M571510 DXS DESCRIPTIONS (Continued from Page 1) and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. Additional Insureds: City of Fort Collins. This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract. AMS 25.3 (2009/09) 2 Of 2 #S571535/M571510