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Home My WebLink About102829 DON KEHN CONSTRUCTION INC - INSURANCE CERTIFICATE (9)rneniir s77in RDONKEHN ACORD,. CERTIFICATE OF LIABILITY INSURANCE ATE (MMIDD/YYYY) o1001/2011 10/01/2011 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 Willis of Colorado, Inc. CONTACT NAME: PHONE 303 722.7776 ac, Ho; 303-722-8862 AID, No, Ezt : E-MAIL ADDRESS: 720 South Colorado Boulevard INSURER(S) AFFORDING COVERAGE NAIC# Suite60ON INSURER A: Pinnacol Assurance 41190 Denver, CO 80246 INSURED Don Kehn Construction, Inc. 6550 SCRS Fort Collins, CO 80528 INSURER B: INSURER C INSURER D INSURER E INSURER F : COVERAGES rPRTIPIrATF NIIMRFR- 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 CONTRACTOR 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 LTR TYPE OF INSURANCE ADOLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MMIDD/YYYY)_ LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ PREMISES(ERENTED occu Dnce $ MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Par accident) $ PROPERTYDAMAGE Pcraccident $ E UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ I AGGREGATE $ DED RETENTION $ S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N OFFICERIMEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS hel. NIA 2093950 0/01/2011 10/01/201 X we srATu- oTH- QRYLIMID E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE- POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is mr,ulmd) Project Description: 6045 Asphalt Supply City of Fort Collins Administrative Services Purchasing Division PO BOX 580 Fort Collins, CO 80522-0580 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 ACORD 25 (2010/05) 1 of 1 #S863978/M863967 I919C0-ZU'lU AL-VKV I,UKrUKAI IUN. All ngnus reserves. The ACORD name and logo are registered marks of ACORD 8MSTY