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HomeMy WebLinkAbout102829 DON KEHN CONSTRUCTION INC - INSURANCE CERTIFICATE (13)Client#: 51160 DONKEI ACORD.CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE DATE 10/21/201/2014 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 endomement(s). PRODUCER &Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 CONTACT NAME; Dana M. Stewart M970 506 6845Flood PuONNo Eat : 970 266 7149 A/c No : EMAIL ADDRESS: Dstewart@floodpeterson.com d eterson.com INSURER(S)AFFORDING COVERAGE NAICp 970 356-0123 INSURER A: The Cincinnati Insurance Compan 10677 INSURED Don Kahn Construction Inc. v 6550 S. County Road 5 Fort Collins, CO 80528 INSURER B: INSURER C ISURER 0 N INSURER E INSURER F : CnVFRAGFS 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. INSR LTR TYPE OF INSURANCE ADOLSUB INSR MD POLICY NUMBER POLICY EFF MMIDO POLICY UP MM1GDM^/Y LIMBS A GENERALLMBILITY X COMMERCIAL GENERAL LIABILITY CLAIMS�.IADE 51OCCUR X PDDed:1,000 CPPI084111 1101/2014 11/01/2011 EEALC1HHOOECTCURRENCE $1000000 PREMISES EaEoMxuErrence $500000 MED EXP (Arty one person) $10 000 PERSONALBADVINJURY E1000,000 GENERAL AGGREGATE E2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PR0JECT LOD PRODUCTS-COMP/OP AGO 52000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED UTOS AUTOS NON -OWNED X Hive Oth Car AUTOS X AUTOS X rive Oth Car CPPI084111 1/01/2014 11/01/201 EaaBINEDSINGLELIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE CPPI084111 11/01/2014 11/0112015 EACH OCCURRENCE s3000000 AGGREGATE s3,000,000 DED I I RETENTION$ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED'! (Mandatanr In NM) If yes, desmide under DESCRIPTION OF OPERATIONS bebw NIA WCSTATU-ITS OTH- ER E.L. EACH ACCIDENT S E.L.DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mdro apace la required) Project Description: Mining Reclamation Agreement regarding Arapahoe Bend Natural Area The following are Additional Insureds as respects General Liability only if required by written contract and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. Additional Insureds: City of Fort Collins. This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract. Cityof Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S944424IM944069 PJE Client#: 52210 8DONKEHN ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATEIYYYY) 10/22/202/2014 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 CONTACT NAME: Willis of Colorado, Inc. we°,"NSid:303722-7776 Ac,Nei, 303-722-8862 2000 South Colorado Boulevard E-MAIL Tower 11, Suite 900 ADDRESS: Denver, CO B0222 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: PinnacolAssurance 41190 INSURED INSURERS: Don Kahn Construction, Inc. 6550 SCRS 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 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 ADDLSUB INSR WVD POLICY NUMBER POLICY EFF MMIDD/YY POLICY EXP MMIDD/YV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMIBES Ea occurrence $ MED EXP (Any one person) $ CLAIMS -MADE [—]OCCUR PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY PRO- LOC JECT $ AUTOMOBILE LIABILITY EOa eBINED SINGLE LIMIT $ BODILY I NJURY(Per person) $ ANY AUTO ALL OS SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE Per accitlent $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? � NIA 2093950 10/01/201410101/201 X WC STATU- oTH. E.L. EACH ACCIDENT s500,000 E.L. DISEASE - EA EMPLOYEE $500000 (Mandatory in NH) If yes, deunba under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT s500,000 Tt I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project Description: 6045 Asphalt Supply City of Fort Collins Administrative Services Purchasing Division PO Box 580 Fort Collins, CO 80522-0580 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 #S1120694/M1118585 V Ibbb-ZOl U AUUKU UUKPUKA I JUN. All rights reserved. The ACORD name and logo are registered marks of ACORD SALIN