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HomeMy WebLinkAbout102829 DON KEHN CONSTRUCTION INC - INSURANCE CERTIFICATE (11)Client#: 52210 8DONKEHN ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYYI 09/2412013 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. H 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 CONTACT NAME: Willis of Colorado, Inc. PaHONEcNo 303 722-7776 AIC No : 303-722-8862 Sao: 2000 South Colorado Boulevard E-MAIL Tower II, Suite 900 ADDRESS: IORDINGCOVERAGE NAICp Denver, CO 80222 INsuRERA:PlnnacolAssurance 41190 INSURED INSURER B : Don Kahn Construction, Inc. 7 }� 6550 SCR5 (0 ` t/ z INSURER C: Fort Collins, CO 80528 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 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. MR lT TYPE OF INSURANCE ADD L 9UB POLICY NUMBER MM/DDY� MM/DCYEXP LIMITS GENERAL LIABILITY EE�AAqACCkk��HHA E COMMERCIAL GENERAL LIABILITY �OEECCC7URR�RE�ENCE PREMISES Ee am I hce E CLAIMS -MADE F—IOCCUR MED EXP(Any one person) E PERSONAL& ADV INJURY E GENERALAGGREGATE E GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG E 17 POLICY PRO- JECT r-1 LOC E AUTOMOBILE LIA Ea acddanlBILITY COMBINED SINGLE LIMIT BODILY INJURY (Per person) E ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per eceldent) E HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE parecddant E E UMBRELLA LIAB OCCUR EACH OCCURRENCE E AGGREGATE E EXCESS LIAB CLAIMS -MADE DED RETENnONE E A WORKERS COMPENSATION AND EMPLOYERS' LIABLT' YIN ANY EARLUDER07ECUT�W N/A 2093950 010112013101011201 X T 5TATU- EI EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE E51111000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS be. E.L. DISEASE -POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) RE: Case #: 2012-CV-1477 City of Fort Collins 300 La Porte Avenue Fort Collins, CO 80522 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 #S1062194/M1062174 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 8TBEC Client#: 52210 8DONKEHN ACORD.., CERTIFICATE OF LIABILITY INSURANCE DATEYYY ) 09/24/204/2013 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 endorsement(s). PRODUCER CONTACT NAME: Willis of Colorado, Inc. PHONED Ezl: 303 722-7776 ayNo): 303-722-8862 2000 South Colorado Boulevard E-MAIL ADDRESS: Tower II, Suite 900 Denver, CO 80222 INSURERS AFFORDING COVERAGE NAIC INSURER A: Plnnacol Assurance 141190 INSURED INSURER B: Don Kohn Construction, Inc. NSURER C 6550 SCRS - -- INSURER D: Fort Collins, CO 80528 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 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. M6RR TYPE OF INSURANCE ADDL SUB POLICYNIUMBER MMIDCYEFF MMPIDCYEXP LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR E pEpgAqCCL�HAA�GGOEEC7C7URppRENCE PREMISES EaEONTTrED E MED EXP (Any one person) E PERSONAL S ADV INJURY E GENERAL AGGREGATE E GEWL AGGREGATE LIMIT APPLIES PER POLICY PRO. LOC PRODUCTS-COMP/OP AGG E $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED RAUTOS HOS HIED NON -OWNED RED AUTOSAUTOS COMBINED SINGLE LIMIT Ea accident j, BODILY INJURY (Per parson) E BODILY INJURY (Per accident) E PROPERTYDAMA PaE r accident E S UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE E AGGREGATE E DEED I I RETENTIONS E A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNERIEXECLMVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA 2093950 0101/2013101011201 X WCSTATU- OTH- E.L. EACH ACCIDENT 11500 000 E.L. DISEASE- EA EMPLOYEE s500 D00 EL. DISEASE -POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if morn space is required) Project Description: 6045 Asphalt Supply Cityof Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Administrative Services ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Division PO BOX 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522-0580 I.frn'vt-L��-YV. l_Dm�bLQ.Q © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1062195/M1062174 8TBEC