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HomeMy WebLinkAbout188139 DOHN CONSTRUCTION - INSURANCE CERTIFICATEOP ID: RC A`�RO" CERTIFICATE OF LIABILITY INSURANCE D09/2 12014Y) 09/25I2014 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 200 Johnstown, CO 80534 Dave Janssen CONTACT NAME: PHONE PAX JAdC, No Eat : INC, No: ADE-DRESS:MAIL PRODUCER DOHNC-2 CUSTOMER ID 0: INSURER 5 AFFORDING COVERAGE NAIC N INSURED Dohn Construction, Inc. INSURER A: EMC Insurance Companies 21415 DCI Residential, LLC INSURERS: 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. ILTR TYPE OF INSURANCE INSR ADOL WID SUBS POLICY NUMBER MINDDY MMIEFFU00 YYYEXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X Blanket Add'llns 1R57255 10/01/2014 10/01/2015 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES ffa occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 X Blanket Waiver GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC IFCT PRODUCTS-COMPIOP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS 1Z57255 10/01/2014 10/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY person) $ BODILY INJURY accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ X X $ $ q X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 1J57255 1010112014 10101I2015 EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,0D DEDUCTIBLE RETENTION 3 g _ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORtPARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under OE SCRIPTION OF OPERATIONS below NIA 3055407 07/01/2014 07/01/2015 WC STATU- I OTH- X TORY LIMITS Par EL EACH ACCIDENT $ 1,000,00 EL DISEASE - EA EMPLOYEE $ 1,000,00 E. L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES (ANach ACORD 101, Additional Remarks Schedule, If more apace 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 4d,zAv1-W1 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: RC ,acoRa' CERTIFICATE OF LIABILITY INSURANCE DATE 09/25/2014 5/2014 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 endorsements . PRODUCER PFS Insurance Group -JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Dave Janssen-ADDRESS' CONTACT NAME: PHONE FAX (AIC, No Eat : INC, No), E-MAIL PRODUCER DOHNC-2 CUSTOMER ID, INSURER(S) AFFORDING COVERAGE NAIC M INSURED Dohn Construction, Inc. INSURER A: EMC Insurance Companies 21415 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 LTR TYPE OF INSURANCE ADDL UBR I POLICY NUMBER POLICY EFF (MMIDDIYYYYI POLICY EXP IMMIDDIYYYYILIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 1R57255 10/01/2014 10/01/2015 DAMA ETO-REN TEff— PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 Blanket Add'I Ins X Blanket Waiver GENERALAGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,00 POLICY X PHI LOC $ A AUTOMOBILE LIABILITY ANY AUTO 1Z57255 10/01/2014 10/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEOULEDAUTOS HIRED AUTOS PROPERTY DAMAGE (PER ACCIDENT) $ X X $ NON-OWNEDAUTOS X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 A EXCESS LIAS CLAIMS -MADE 1J57255 10I0112014 1010112015 DEDUCTIBLE $ $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFDCERIMEMBER EXCLUDED? (Mandatory in NH) NIA 3055407 07/01/2014 07/01/2015 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 EL DISEASE -EA EMPLOYEE $ 1,000,00 If yes, describe under DE SCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT $ 1,000,00 A Builders Risk 1X57255 10/01/2014 10/01/2015 One Loc. 5,000,00 All Loc 5,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If men, 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 is 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 4 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: RC Alft " CERTIFICATE OF LIABILITY INSURANCE D09/25/2014AM Y) 09/25/2014 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 endorsements . PRODUCER PFS Insurance Group -JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Dave Janssen CONTACT PHONE FAx IAIC. No EXt: INC. No: E111AIL ADDRESS:PRODUCER CUSTOMER ID, DOHNC-2 INSURER(S) AFFORDING COVERAGE NAICa INSURED Dohn Construction, Inc. INSURERA: EMC Insurance Companies 21415 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. ILNSR TR TYPE OF INSURANCE INSR U I POLICY NUMBER MMDDD/YYYY MWDDEFFY/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE J OCCUR Blanket Add'I Ins 1R57255 10/01/2014 10/01/2015 EACH OCCURRENCE $ 1,000,00 DAAEMISES Ea NT ante $ 100,00 MED EXP(Any one person) $ 6,00 PERSONAL B ADV INJURY $ 1,000,00 X Blanket Waiver GENERALAGGREGATE $ 2,000,0010 GENL AGGREGATE LIMIT APPLIES PER POLICY X PRO LOC PRODUCTS - COMPIOP AGO $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS 1Z57255 10/01/2014 10/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accitlenU $ PROPERTY DAMAGE (PER ACCIDENT) $ X X $ Is A X UMBRELLA LB EXCESS LIAR X OCCUR CIAIMS-MADE 1J57255 1010112014 10101/2015 EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 3055407 07/01/2014 07/01/2016 WC STATUOTH- X I - R E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 A Builders Risk 1X57255 10/01/2014 10/01/2016 One Loc. 5,000,00 All Loc 5,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addldonal Rsmarks Schedule, if more space Is ragalrsd) Re: 7637 General Contractor for Fire Station Expansion 6 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 6 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. AUTHORIZED REPRESENTATIVE .6(?.112.ylf�wr1G._, © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD