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HomeMy WebLinkAbout188139 DOHN CONSTRUCTION INC - INSURANCE CERTIFICATE (5)DOHNCON-01 LPREWITT ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/21/2018 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 have ADDITIONAL INSURED provisions or 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: PFS Insurance Group PHONE FAX 4848 Thompson Parkway Suite 200 (A/C, No, Ext): (970) 635-9400 (A/C, No):(970) 635-9401 Johnstown, CO 80534 ADDRE S: info@mypfsinsurance.com INSURED Dohn Construction, Inc. DCI Residential, LLC 2642 Midpoint Drive Fort Collins, CO 80525 F: Pinnacol Assurance Co f`n1L/G0A(]1=C CFRTICICATF MI IMRGR• RFVISInKI All IMRFR• 190 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 LTRA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE I '- I OCCUR 1 R57255 10/01/2018 10/01/2019 DAMAGE TO RENTED PREMISE Ea occurrence 100,000 $ X ME EXP (Any oneperson) $ 6,000 Blanket Addl Insured X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY ❑X JE LOC OTHER. A AUTOMOBILE LIABILITY Ea accident SINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ X ANY AUTO 1Z57255 10/01/2018 10/01/2019 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE Per a. dent $ X HIRED X NON -OWNED ggAUTOS ONLY AUTOS ONLY X Flan ed Addl X Blanket Waiver A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAR CLAIMS -MADE 1P57255 10/01/2018 10/01/2019 AGGREGATE $ 10,000,000 DED I X I RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE 3055407 07/01/2018 07/01/2019 X PER OTH- T T T R E.L. EACH ACCIDENT 1,000,000 $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT If yes, describe under DESCRIPTION OF OPERATIONS below 1,000,000 $ A Builders Risk 1057255 10/01/2018 10/01/2019 Any One Loc. 5,000,000 A Leased/Rented Equip 1057255 10/01/2018 10/01/2019 $1,000 Deductible 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: City of Fort Collins Proposal No. 8546. If required by written contract the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder is named as Additional Insured for ongoing operations and completed operations on a Primary and Non -Contributory basis under General Liability and Automobile Liability. If required by written contract, a Waiver of Subrogation in favor of the Certificate Holder applies to the General Liability, Automobile Liability and Workers' Compensation. Umbrella provides excess coverage over the General Liability, Automobile Liability and Employers' Liability. City of Fort Collin Purchasing Division 215 North Mason Street, 2nd Floor Fort Collins, CO 80524 t;A N 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 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD