HomeMy WebLinkAboutDON KEHN CONSTRUCTION INC - INSURANCE CERTIFICATE (4)rTANKFNPC..
ACORD,a CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDNYYY) )9/27/2019
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 1s 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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER-
Holmes Murphy - Colorado
7600 East Orchard Road, Suite 230 South
gE; Colleen Luther
PONE Eae . 720-458-5744 AIc No
Afkss; cluther@holmesmurphy.com
INSURERS) AFFORDING COVERAGE
NAIC0
Greenwood Village, CO 80111
INSURER A: Pinnacol Assurance Company
41190
INSURED
Don Keh-n Construction; Inc.
6550 S. County Road 5
Fort Collins, CO 80628
INSURER B :
INSURER C :
INSURER D.:: _
INSURER E
INSURER F-:
r^%2 A^_¢e PeoTICN-ATC ullaaneo• RF•VISION 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
ADDLBUIBR
INSR
WVD
POUCYNUMBER
POLICY EFF
MMID
MPMOIlD1CDY/YEYXYPY
LIMITS _
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
EACH OCCURRENCE
$
RENca�irrence
PREMISES
$
MED EXP (Arty one peram)
$
-
PERSONAL 6 ADV INJURY
$
G_EN'L AGGREGATE LIMIT APPLIES PER:
❑ PRCTO- O LOC
POLICY JE
_ OTHER:
GENERAL AGGREGATE
$
PRODUCTS-COMP/OP AGG
$
$
AUTOMOBILE' LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY " AUTOS
AUTOS ONLY .AUTOS ONLDV
_
CONED
Ee amidemSINGLE LIMIT
BODILY INJURY (Per perem)
$
BODILYINA*(Per accident)
$
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAR
EXCESS UAB
OCCUR
CLAIMS -MADE
-
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTIONS
$
A
WORKERS COMPENSATION
AND EAPLOYERIr-4ARL TY YIN
O ICERIMEETT 60UPARLUDED.XECUTNE -
(Mandatory in NH)
If yea, describe under
DESCRIPTION OF OPERATIONS below
NIA
X
2693950
0/0112019
1010112020
X PER. OTH-
E.L.EACH ACCIDENT
$500 000
E:L.DISEASE -EA EMPLOYEE
$600 000
E.L. DISEASE - POLICY LIMIT
$500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACCRD Tel, Additional Remarks Schedule, may be etlached M more space In required)
Project:8880 Asphalt Supply
City of Fort Collins -
Purchasing
P.O. Box 580
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.
W 26 (2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD MANV7
#S478128/M478109