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HomeMy WebLinkAbout188139 DOHN CONSTRUCTION INC - INSURANCE CERTIFICATE (3)OP ID: RC A41% ' CERTIFICATE OF LIABILITY INSURANCE D06/12ATE /2014 os/1z/2o1a 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 PFS Insurance Group - JT 4848 Thompson Pkwy, Ste 200INC.No Johnstown, CO 80534 Dave Janssen CONTACT PHONE FA% Eat: ac No: EMAIL ADDRESS: PRODUCER DOHNC-2 CUSTOMER ID d: INSURERS AFFORDING COVERAGE NAIC K INSURED Dohn Co'fil6teuction, Inc. INSURER A: Employers Mutual DCI Residential, LLC 2642 Midpoint Drive Fort Collins, CO 80525 INSURER B: Pinnacol Assurance 41190 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 LTR TYPE OF INSURANCE AO UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY E%P MM/DD/WYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-1 OCCUR 1R57255 1010112013 10/01/2014 DAMAGE TO_RENTrff_ PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 Blanket Add'I Ins X Blanket Waiver GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: POLICY FXI PROT n LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO 1Z57255 10/01/2013 10/01/2014 COMBINED SINGLE LIMIT (Ea accident) . $ 1,000,00 X BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS X PROPERTY DAMAGE (PER ACCIDENT) $ X NON -OWNED AUTOS $ X UMBRELLA LIMB X OCCUR EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 A EXCESS LIAB CLAIMS -MADE 1J57265 10/01/2013 10/01/2014 DEDUCTIBLE $ $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' UABILITY AN V PROPRIETOR/PARTNER/EXECUTIVIE Y/N OFFICER/MEMBER EXCLUDED? N/A 3055407 07/01/2014 07/01/2015 WC STATU- OTH- X TORY II ER E.L. EACHACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 A Builders Risk 1X57255 10/01/2013 10/01/2014 One Loc. 5,000,00 All Loc 5,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, ACdiflamd 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 ms 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. AUTHORIZED REPRESENTATIVE A ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: RC '4� Rom' CERTIFICATE OF LIABILITY INSURANCE O06112ATE /2014YI 06/12/2014 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 PFS Insurance Graup -JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Dave Janssen CONTACT PHONE FAX IND. No: EMAIL ADDRESS, PRODUCER DOHNC-2 CUSTOMER ID P: INSURERS AFFORDING COVERAGE NAIC N INSURED Dohn Construction, Inc. INSURER A: Employers Mutual DCI Residential, LLC 2642 Midpoint Drive Fort Collins, CO 80525 INSURERS:Pinnacol Assurance 41190 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 LTR rypE OF INSURANCE L UBR POLICY NUMBER POLICY EFF MMIOD/YYYY POLICY EXP MM/DD/Y1'YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR 1R57265 10/01/2013 10/01/2014 PREMISES Ea occu D $ 100,00 MED EXP (Any one person) $ 5,00 Blanket Add'I Ins PERSONAL B ADV INJURY $ 1,000,00 X Blanket Waiver GENERALAGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 17 POLICY X PRO- LOC $ A AUTOMOBILE LIABILITY ANY AUTO 1Z57255 10/01/2013 10/01/2014 COMBINED SINGLE LIMITJEa $ 1,000,00 X BODILY INJURY BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS X PROPERTYE (PER ACCIDENT) $ X $ NON -OWNED AUTOS X I UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 A EXCESS LIAS CLAIMS -MADE 1J57255 10/01I2013 10/01/2014 DEDUCTIBLE $ Is RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? NIA 3055407 07/0112014 07/01/2015 WC STATD- OTH - X TORV LIMI ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory in NH) If as, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT I $ 1,000,00 A Builders Risk 1X57255 10/01/2013 10/01/2014 One LOC. 5,000,00 All LOC 5,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Re: 7637 General Contractor for Fire Station Expansion S Renovation Projects. If required by written contract or written agreement the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder is included as Additional Insured for ongoing s completed operations under General Liability. CITYOFC City of Fort Collins Financial Services Purchasing Division 215 N. Mason Street 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. AUTHORRED REPRESENTATIVE U 1911 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD OP ID: RC ,a►coizo CERTIFICATE OF LIABILITY INSURANCE �� °06/1 12014ATE ' 06/12/2014 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 PFS Insurance Group -JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Dave Janssen CONTACT PHONE FAx _(NC No Ea<: ac No E-MAIL ADDRESS: PRODUCER DOHNC-2 CUSTOMER ID d: INSURERS AFFORDING COVERAGE NAIC d INSURED Dohn Construction, Inc. INSURERA: EmplO ersMutual DCI Residential, LLC 2642 Midpoint Drive Fort Collins, CO 80525 INSURER B: Pinnacol Assurance 41190 INSURER C: INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NIIMRFR- 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 LTR TYPE OF INSURANCE A L SUB POLICY NUMBER POLICY EFF MMIDDM POLICY E%P MOVICO YYY I I LIMITS GENERAL LABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1K OCCUR 1R57255 10/01/2013 10/01/2014 -PREMISES, Eao urrence $ 100,00 MED EXP (Any one person) $ 5,00 X BlanketAdd'Ilns PERSONAL BADVINJURY $ 1,000,00 X Blanket Waiver GENERAL AGGREGATE $ 2,000,0011 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,00 POLICY X I PRO-LOC $ A AUTOMOBILE LIABILITY ANY AUTO 1Z57255 10/01/2013 10/01/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) S ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS X PROPERTY DAMAGE (PER ACCIDENT) $ X NON -OWNED AUTOS $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 A EXCESS LIAR CLAIMS -MADE 1J57255 10I01/2013 10I0112014 DEDUCTIBLE $ $ RETENTION $ B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY ANY PROPRIETORA'ARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLU DED? NIA 3056407 07/01/2014 07/01/2015 WC STATU- OTH- X T TSI ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EL.DISEASE - POLICY LIMIT I $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONSI 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