HomeMy WebLinkAboutDON KEHN CONSTRUCTION INC - INSURANCE CERTIFICATE (7)® CERTIFICATE
ACORO
OF LIABILITY INSURANCE
uATEtMMmDrcvrrl
10/242019
THIS CERTIFICATE It ISSUED AS A MATTER OF INFORMATION
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
ONLY AND CONFERS NO RIGHTS UPON THECERTIFICATE`HOLDER. THIS
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,
If SUBROGATION IS WAIVED, subject to the terms and conditions
this certificate does not confer rights to the certificate holder
the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
of the policy, certain policies may require an endorsement A statement on
Iln 11eu of -such endorsement(s).
PRODUCER
Flood and Peterson
PO Box 578
Greeley CO80632
NAME: Deha Stewelt, QIC, CISR
PHONE Efi (970)-2667149 Ne : (970) 50"845
- DStewartC800dpeterson.com
ADDRESS•
INSURER(S) AFFORDING COVERAGE
NAIC If
INSURER A: Cincinnati Insurance Go
10677
INSURED
Don Kohn Construction Inc.
6550 S. County Road 5
Fort Collins COS
80528
INSURER B :
INSURER C:
INSURER D:
INSURER E :
INSURERF:
C(1VFRA(.FS CFRTIFICATE NtIMRFR- I GUAU1XS x11/2020 REVISION NUMRFRr
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SE Ow HAVE BEEN ISSUED TO THE INSURED NAMED ASOVEFOR 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 INSU RANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, _
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
INS.
POUCY.NUMBER
M
MMIDD
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE.
$ 1,000,000
CLAIMS -MADE ® OCCUR
I
PREMISES Eadccurrence
$ 500,000
MED EXP (Any one Own
$ 10,000
PERSONALSADVINJURY
s 1,000,000
A
EPP045
666
11/0112019
11/012020
GENLAGGREGATE UMITAPPLIES PER:
GENERAL AGGREGATE
E 2,000,000
JECOT LOC
POLICY ® J
PRODUCTS-COMPIOPAGG
E 2,000,000
E
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
EPP 045
96 66
11/012019
11/01&620
BODILY INJURY (Per amident)
s
PROPERTY DAMAGE
Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
s
UMBRELLA LIA8
OCCUR
EACH OCCURRENCE
3,0,00
$ 000
AGGREGATE
$ 3,000,000
A
EXCESSLUI6
CLAIMS -MADE
EPP045I9666
11/012019
11/012020
.DED. .RETENTION.$ 0
$
1
1
WORKERS COMPENSATION_
m -
AND EMPLOYERS' LIABILITY Y 1 N
STATUTEPER EROTH -
ANY PROPRIETORIPARTNERIEXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
NIA
E.L. EACH ACCIDENT
$
(Mandatory In NMI
E.L. DISEASE- EA EMPLOYEE
$
If yea, deWbe urMer
DESCRIPTION OF OPERATIONS balm
E.L. DISEASE -POLICY LIMIT
$
DESORPTION OF OPERATIONS I LOCATIONS (VEHICLES (ACORD 101, pddltlo
M RemadM Schedule, may be attached If more space is regWrad)
Certificate holder is included as Additional Insured as required by written
contract with. respects to General Liability and Automobile Liability.
CERTIFICATE HOLDER I CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
The City of Fort Collins
ACCORDANCEWITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE
J
Fort Collins
co 80522
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACO name and logo are registered marks of ACORD