HomeMy WebLinkAboutDON KEHN CONSTRUCTION INC - INSURANCE CERTIFICATE (5)ACC)Rbr CERTIFICATEIOF LIABILITY INSURANCE DAT1024/2019E /24/20/19
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERSNO 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 "OLDER.
1f SUBROGATION IS WANED, subject to the terms and
this certificate does not confer rights to the certificate
Flood and Peterson
PO Box 578
Greeley
Don Kehn Constriction Inc.
6550 S. County Road 5
Fort Collins
of the policy, certain policies may require an endorsement A statement on
80632
COVERAGES CERTIFICATE NUMBER: 1 GL/AU/XS z112020 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW
HAVE. BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM.OR.CO
DITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO NMICH THIS
CERTIFICATE MAYBE 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.
LTR.
TYPE OF INSURANCE
INSO
WWD1
POLICY NUMBER
MWOONYYY)
(MWDONYYYI
LIMA
COMMERCULLGENEfUU.uAwuw
EACH OCCURRENCE
E 1,000,000
CLAIMS -MADE ® OCCUR
DAMAGE TO RENTED
PREMISES(Edoccurrence)
E W0,000
MED EXP Anyone non
E 10.000
PERSONAL aADVINJURY
$ 1.000,000
A
EPP 045
96 66
11/01/2019
11/012020
GEN'LAGGREGATE OMIT APPLIES PER:
GENERAL AGGREGATE
E 2.000,000
POLICY ® JECT 7 LOC
PRODUCTS -COMPIOPAGG
E 2,000,000
E
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident)
E 1,000,000
BODILY INJURY (Per person)
E
ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
EPP 045
9666
11/012019
11/01/2020
BODILY INJURY (Per accident)
E
PROPERTY DAMAGE
Per accident
E
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
E
UMBRELLA LAB
OCCUR
EACH OCCURRENCE.
E 3,000,000
AGGREGATE
E 3,000,000
A
EXCESS LU18
CLAIMS -MADE
EPP 045
96 66
11/012019
11/012020
OED I X RETENTION E 0
$
WORKERS COMPENSATION
ANDEMPLOYERS'LIABILITY YIN
PERT OTH-
STUTE ER
E.L. EACH ACCIDENT
E
ANY PROPRIETORIPARTNER/EXECUTIVE ❑
OFFICERIMEMBER EXCLUDED?
NIA
(Mapdalory lq NH)
Lry
E.L DISEASE - EA EMPLOYEE.
E
tl yea, be under
DESCRIPTION OFOPERATIONS below
E.L. DISEASE -POLICY LIMIT
S
DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES IACORD tat. AdAltlonel
Remarks ScbeAule, may Da altielieE If inors speea le requlred)
Project Description: 8310 Aggregate Supply
Certificate holder is included as Additional Insured as required by written
contract with respects to liability arising out of work performed by the named
insured.
The City of Fort Collins Purchasing Department
PO Box 580
Fort Collins
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
�O 80522-0580
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