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Home My WebLink About102829 DON KEHN CONSTRUCTION INC - INSURANCE CERTIFICATE (7)ClipntN- 51160 DONKEI ACORD.M CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DONYYY) 11/01/2012 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. P. O. Box 578 Greeley, CO 80632 NTACT NAME: Dana M. Stewart PHONE g70 266 7149 F"% 970 506 6845 NC No Ext : A/C, No ADDRESS: Dana.Stewart@floodandpeterson.com 970356-0123 .�p� 0 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC9 INSURED Don Kehn Construction Inc. INSURER A: The Cincinnati Insurance COmpan 10677 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. L R TYPE OF INSURANCE S NVD B POLICY NUMBER MM%DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR X PDDed:1,000 CPP1084111 11/01/2012 11/01/2012 EACH OCCURRENCE $1 OOOOOO DAMAGE TO RENTED PREMISES (Ea occurrence) $500000 MED EXP (Any one person) $1 O 000 PERSONAL & ADV INJURY $1,000000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY-X] PRO LOC PRODUCTS COMP/OPAGG 52,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car CPP1084111 11/01/2012 1110112012 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) S X X $ X IS A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPP1084111 11/01/2012 11/01/201 EACH OCCURRENCE s3000000 AGGREGATE s3,000,000 DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? (Myandatory in NH) It s, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU OTH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD lot, Additional Remarks Schedule, if more space is required) Project Description: Mining Reclamation Agreement regarding Arapahoe Bend Natural Area The following are Additional Insureds as respects General Liability only if required by written contract (See Attached Descriptions) City of Fort Collins 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 (2009/09) 1 of 2 #S745951/M745929 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DXS