HomeMy WebLinkAboutDMD CONSTRUCTION INC - INSURANCE CERTIFICATEFrom. Morgan Fugate At: Brown 8 Brown Insurance of Colorado Fa%ID'. (970) 484-4165 To: Fort Collins- Loveland
Date: 2202012 02:15 PM Page: 1 of 2
q OR� CERTIFICATE OF LIABILITY INSURANCE OP ID FM
DAM(MAIDDIYYYI)
02/20/12
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:the certificate holder Is an ADDITIONAL INSURED, the po cy es must be endorsed. SUBROGATION 15 WAIVED, subjecitto
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 endorsemerf `
PRODUCER
NAME:
PHONE oX
(,C. No. Ent): (P/C. NI
Brown S Brown Inc
GrE
ADDRESS:
4532 Boardwalk Dr, Suite 200
Fort Collins CO 80$25
CUSTOMERIDR DMDCO-1
Phone:970-482-7747 Fax:970-484-4165
INSURER(S) AFFORDING COVERAGE
NMC*
INSURED
INSURER A: yeatriald I-- C..Pany
24112
DMD Construction, Inc.
3801 Weicker Dr
INSURER B:
INSURER c'
'Ft Collins CO 80524
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 ME IIJSURED 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, TIE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY IWVE BEEN REDUCED By PAID CLAIMS
LTR
TYPE OF INSURANCE
INSIR
WV
POLICY NUMBER
Q41,`IYYYY)
FAY
(-MLlp` TW)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
51,000,000
A
TXC��YERCIAL GENERAL LIABILITY
rLAIMS-MADE 51 OCCUR
CWP5113279
02/25/12
02/25/13
PREMISESIEa OCCVraTce)
$300,000
I.EDEXP(AnYaleoersan)
$10,000
PERSONAL S ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
s2,000,000
GENE AGGREGATE LIMIT APPLIES PER.
PRODUCTS - COMPIOP AGO
$2,000,000
POLICY I-X7 PE° F7 LOC
$
A
AUTOMOBILE
X
LIABILITY
My AUTO
CWP5113279
02/25/12
02/25/13
COMBINED SINGLE LIMIT
$1,000,000
E ILY INJURY
eooaY MJURv )Per person)
g
ALL OWNED NJTOS
BODILY INJURY (Per accident)
$
SCHEOIAEDAUTOS
HIRED AUi05
PROPERTY DAMAGE
)Per accident
$
NONONMED AUTOS
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
EXCESS LIA9
CLAIMSMPDE
AGGREGATE
$
DEDUCTIBLE
$
RETENTION $
$
WO S COM
AND EMPLOYERS'LIABILETY YIN
ANY PRCPRIETORPPRTNERIEXECUTIVE
OFFICER,MEnEER EXCLUDED? �.
(Mandelory In NH)
If Ves, desnbe urwer
IA
_
_ .�
-
-
TORYLIMITS ER
EL EACH ACCIDENT
f
EL. DISEASE - EA EMPLOYEE
f
E L DISEASE - POLICY LIMIT
f
DESCRIPTION OF OPERATIONS tam
A
Builders Risk
CWP5113279
02/25/12
02/25/13
Bdr Risk 100,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AmcC ACORD 101, Additional Remarks Sd,edule, a more apace Is re4ulred)
PREFABRICATED BLDG ERECTION - Location 5295 Beech Craft, Loveland, CO - City
of Fort Collins and The City of Loveland are included as Additional Insured
with respects to General Liability.
Fax# 221-6327
CERTIFICATE HOLDER CANCELLATION '
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
FTC/LOV THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELNERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Fort Collins - Loveland"- --" AUTHORIZED REPRESENTATI
Municipal Airport I
4900a Earharcit-Road Tyler B. Allen
reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
...
,from: Morgan Fugate At: Brown & Brown Insurance of Colorado FaxID: (970) 484-4165 To: Fort Collins- Loveland Date: 2202012 02:15 PM Page: 2 of 2
i,�L�,�, ,�,11�r�NR�fuB �,AN�E:Dbm�,ConStr�cii�n Inc ,r•� ,�,, ;,�„6P IDxcH'� I+'+�sp DRTE, 72/20%'12
When required by written contract the following applies
Blanket Additional Insured - Onging - CG3227 06/10
Blanket Additional Insured - Completed operations CG7133 02/11
Primary and Non -Contributory - CG7055 12/98