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HomeMy WebLinkAbout188139 DOHN CONSTRUCTION INC - INSURANCE CERTIFICATEUP IU: R(; ,4coR0 CERTIFICATE OF LIABILITY INSURANCE D06/10ATE /2013V) 06110/2013 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 endorsements . PRODUCER Phone: 970-635-9400 CONTACT NAME: PFS 1pson Group - JT p wy, Ste 200 Fax: 970-635-9401 4848 ThomPk Johnstown, CO 80534 Dave Janssen PHONE PHONE IN C, No): Ng_Exn; E-DRESS:MAIL ADPRODUCER ID N: DOHNC-2 _CUSTOMER _ INSURERS) AFFORDING COVERAGE I NAICd Is$I�� INSURED Dohn Construction, Inc. INSURER A: Employers Mutual DCI Residential, LLC INSURER B:Pinnacol Assurance 41190 2642 Midpoint Drive Fort Collins, CO 80525 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 ADDL'SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I POLICY NUMBER MWDD/ MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR 1R57255 10/01/2012 10/01/2013 DAMAGE IURENILU PREMISES (Ea occurrence) MED EXP(Anyone person) $ 100,000 $ 5,000 PERSONAL BADV INJURY $ 1,000,00 X Blanket Add'I Ins X Blanket Waiver GENERAL AGGREGATE $ 2,000,00 GENI A( GGATGRETE LIMIT APPLIES PER: RO n LOC POLICY X PECT PRODUCTS - COMP/OP AGG $ 2,000,00 s A AUTOMOBILE LIABILITY ANY AUTO 1Z57255 10/01/2012 10/01/2013 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Peracciaent) S X $ NON-OWNEDAUTOS I$ HUMBRELLA LIAR X OCCUR EACH OCCURRENCE 10'000'000 AGGREGATE $ 10,000,00 A _- EXCESS LIAB CLAIMS -MADE 1J57255 10/01/2012 10/01/2013 $ DEDUCTIBLE Is RETENTION $ B WORKERSCOMPENSATON ANDEMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBER E%CLUDED? (Mandatory In NH) NIA 3055407 07/01/2013 07/01/2014 WC STATU- OTH- X T00.Y LIMITS��ER_ EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE$ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below I . DISEASE - POLICY LIMIT 1 $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RE: Service Contract. If required by written contract or written agreement, The City of Fort Collins is included as additional insured for ongoing operations and completed operations under general liability. CITYFCI City of Fort Collins City's Director of Purchasing & Risk Management P.O. 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) The ACORD name and logo are registered marks of ACORD DD CERTIFICATE OF LIABILITY INSURANCE I DATE(MMI2013Y 06/10/0131 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 endorsementlsl. PRODUCER Phone: IFS Insurance Group -JT Fax: 1848 Thompson Pkwy, Ste 200 Johnstown, CO 80634 NAIC N INSURED Dohn Construction, Inc. INSURER A: Employers Mutual DCI Residential, LLC INSURER B: Pinnacol Assurance 41190 2642 Midpoint Drive Fort Collins, CO 80525 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. IYXP RINSRIWVOI POLICY NUMBER MMIDDYYYY MINS SUADOLSUBRMDLIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLNMSfMADE FRI OCCUR 1 R57255 1010112012 1010112013 DAMAGE To RENTED PREMISESJEa_occurrencej MED EXP (Any one person) 1 $ 100,00 $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 Blanket Add'I Ins X Blanket Waiver GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS -CONI AGG $ 2,000,00 POLICY 7s I PECT RO- LOC $ A AUTOMOBILE AUTOMOBILE LIABILITY ANY AUTO 1 Z57255 10I01I2012 10I01I2013 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) S SCHEDULED AUTOS HIRED AUTOS PROPERTYDAMAGE (Per accident) $ X X $ NON-OWNEDAUTOS $ X UMBRELLA LIAB I X OCCUR I I EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,0O A EXCESS LIAB CLAIMS -MADE 1J57255 70I01I2012 10101I2013 DEDUCTIBLE $ $ RETENTION $ B WORKERS COMPENSATION ANDEMPLOYERS 'LIABILITY ANY PROPRIETOR, PARTNER/EXECUTIVE YIN OFFICER/MEMBER E%CLUDEDp ❑ (Mandatory In NH) NIA 3055407 07/01/2013 07/0112014 X WC STATU-I IOTH- TORY-LIMITST___LER E. L. EACH ACCIDENT $ 1,000,000 E. L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $ 1,000,00 A Risk 1X57255 1010112012I 1010112013 (Builders IOne LoccAll 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Poudre Fire Authority Facilities in Fort Collins. If required by written contract or written agreement the following provisions apply subject to the policy terms, conditions limitations and exclusions: The Certificate Holder as included as Additional Insured for ongoing and completed operations under General Liability. CITYFC City of Fort Collins Financial Services Purchasing Division 215 N. Mason St. 2nd Floor SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORaED REPRESENTATIVE A ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD