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Home My WebLink AboutDOHN CONSTRUCTION INC - INSURANCE CERTIFICATE (3)VY lu: 1 ,acoizo CERTIFICATE OF LIABILITY INSURANCE D09/26/2ATE Y3 09/26/2013 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 PRODUCER Phone: 970-635-9400 iure; ' PFS Insurance Group -JT Fax: 970-635-9401 PHONE FAx 4848 Thompson Pkwy, Ste 200 EA1r lac, No): Johnstown, CO 80534 ADORE65: 11e79:Ll '� INSURED Dohn Construction, Inc. INsuRERA:Em to em Mutual DCI Residential, LLC INSURER 0: Pinnacol Assurance 41190 2642 Midpoint Drive _. INsuRERc: Fort Collins, CO 8OS2S INSURER D : INSURER E : INSURER P : CnVFRAnF.R 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. I TRR TYPE OF INSURANCE POLICY NUMBER M POLICY E L UMTO A GENERAL NLITY X COMMERCIAL GENERALLIILBILITY CLAIMS -MADE 7v7 OCCUR X Blanket Add't Ins 1R57255 10/01/2013 10/01/2014 EACH OCCURRENCE S 1,000,000 PREMISES fEaoccumrlca $ 100,00 NEED EXP (Any one person) $ 610 PERSONAL S ADV INJURY S 1,000,00 X Blanket Waiver GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE POLICY LIMIT APPLIES PER: X PRO LOC PRODUCTS -COMPIOP AGG S 2,000,00 S A AVTOMOBRE LIA91LrrY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 1Z57255 10101/2013 10/01/2014 COMBINED SINGLE LIMIT (Ea accidenp 8 1,000,00 X BODILY INJURY (Per person) S BODILY INJURY (Parawdenl) S PROPERTY DAMAGE (PWa t) S X X S S A X UMBRELLA LIAR EXCESS UAB X OCCUR CLAM64AADE 1J57255 10101/2013 10/01/2014 EACH OCCURRENCE 5 10,000,00 AGGREGATE 5 10,000,00 DEDUCTIBLE RETENTION $ S S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORRARTNERIEXECUTIVE Y OFFICERIMEMBER EXCLUDED? (Mandatory in NH) Use, describe under DESCRIPTION OF OPERATIONS below N/A 3055407 07/0112013 07/01/2014 s, I WC STAT,1UMTOTH- ' ER E.L. EACH ACCIDENT S 1,000,00 E.L. DISEASE - EA EMPLOYE S 1,000,00 E.L. DISEASE - POLICY LIMIT S 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. CFRTIFICATF NM nFR CANCELLATION CITYFCI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins City's Director of Purchasing & Risk Management AUTHORIZED REPRESENTATIVE P.O. Box Fort Collins,sCO 80522 ,� � ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD