HomeMy WebLinkAboutDON KEHN CONSTRUCTION INC - INSURANCE CERTIFICATE (6)ACC)RD CERTIFICATE( OF LIABILITY INSURANCE 11/24/20`T"'
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO RMATI N 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 OOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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-neuOf such endo_rsement(s)._
PRODUCER CONTACT Dana Stewart, CIC, CISR
NAME
Flood and Peterson PNol1E , (970) 266-7149 No): (970) 506-6845
PO Box 578 E-MAIL s_ DSteWart@floOdpetersoil.Com
ADDRE
INSURED
Don Kern Construction Inc.
6550 S. County Road 5
80632
Fort Collins CQ 80528 1INSURER F:
rnUMAOFA CFIMPICATF NIIMRPW I GUAU/XS xll/2020 REVISION NIIMRFR-
NAIC e
10677
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW
HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE.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
RUM
POLICY NUMBER
POLICY FFF
MWD
POLICY EXIF
M
LIMITS
COMMERCIALGENERALWIBILITY
EACH OCCURRENCE
$ 1,000.000
CLAIMS -MADE ® OCCUR
I
PREMISESEeoccurrence
y 500,000
M one n
S 10,000
PERSONAL SADVINJURY
$ 1,000,000
A
Y
EPP045
9666
11/01P2019
11/01/2020
GEN'LAGGREGATE UMITAPPUES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY 19 JEI T LOC
PRODUCTS-COMPIOPAGG
$ 2,000,000
$
.OTHER:.
AUTOMOBILE
LIABILITY
OMBINED SINGLE LIMIT
Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED S87ULED
AUTOS ONLY AUTOS
Y
EPP-045
96 66
1 V01/2019
1 V01/2620
BODILY INJURY (Per aoddent)
S
PROPERTY DAMAGE
Per awderx
S
HIRED NON-OVMED
AUTOS ONLY AUTOS ONLY
_
S
UMBRELLA LWB
OCCUR
I
EACH OCCURRENCE
$ 3,000.000
AGGREGATE
$ 3,000,000
A
DICESSLIAB
CLAIMS -MADE:
EPP0469666
11/01/2019
1110IJ2020
-
DED I X RETENTION S 0
$
WORKERS COMPENSATION
ANDEMPLOYEWLIABILITY YIN
PER OTH-
TATUTE I I ER
ANY PROPRIETOR(PARTNERIEXECLri NE
E.L. EACH ACCIDENT
$
OFFICERIMEMBER EXCLUDED? ❑
N/A
(Mandatory In NH)
E.L. DISEASE- EA EMPLOYEE
$
If yes, desWbe urger
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddNol al
Remerlo Schedule, may be aaeched 0 roans space Is, required)
RE: Project #B16-06 - City of Fort Collins is included as Additional Insured
as required by written contract but only as respects to liability arising out of work
performed by the named insured with respect to the General and Auto
collectible insurance to the fullest extent the law allows per policy terms
Liability. The coverage is primary and .non-contributory to any other valid and/or
and conditions. Waiver ofsubrogation applies in favor of certificate holder as
required by written Contract.
P=O = SAT Vn1 n!O I PA]UnC1 I A"nu
SHOULD ANY OF -THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins
ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins
CO 80522
1
W 1865-2015 AGURLI L;UKPUKAI IUN. All nglns reservea.
ACORD 25 (2016103) The ACOR name and logo are registered marks of ACORD