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HomeMy WebLinkAbout188139 DOHN CONSTRUCTION INC - INSURANCE CERTIFICATE (13)DOHNCON-01 LWEISBROOK CERTIFICA lit OF LIABILITY INSURANCE DATE sisno2o 1 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 BYTHE'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 endorseme s . PRODUCER C ACT PFS insurance Grou 4848 Thompson Parkway Suite 200 PNON, NE FAX Arco, t rt : (970) 635-9400 (AM; No): (970) 635-9401 E AIL , info@mypfsinsurance.com Johnstown, CO 60534 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: Employers Mutual Casualty Company 21415 INSURED INSURER B : Pinnacol Assurance Co 41190 INSURER C : Dohn Construction, Inc, DCI Residential, LLC INSURER D: 26Q Midpoint Drive Fort Collins, CO 60625 INSURER E INSURER F: i rnVFRARFS r2FRTIFICATF NIIMRFR- RF 1ISInN NIIMRFR- 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 TYPE OF INSURANCE ADDL SUBRPOLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXJ OCCUR 1R5725t 10l1/2019 10/1/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO. RENTED PREMISES (Ea occumence) $ 500,000 MED EXP (Any oneperson) $ 10,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � jP(?T LOC OTHER: .GENERAL AGGREGATE $ 2'000'000 PRODUCTS-COMPIOP AGG $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULEDAUgTEODS ONLY AlUp1TOSEEDpBOODILY AUTOS ONLY X AUTO OO Ix 1Z57255 10/1/2019 10/1/2020 COMBINED SINGLE .LIMIT fEa c dentl $ 1,000,000 BODILY INJURY Per rson $ INJURY Per accitlarn $ Pf�W acEoideTMl AMAGE $ A X UMBRELLA u AB IA EXCESS LR X OCCUR CLAIMS -MADE 1P57255 10/1/2019 10/1/2020 EACH OCCURRENCE $ m000,000 AGGREGATE $ 10,000,000 DED I X( I RETENTION $ 10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETggOEERRR/PARTNER/EXECUTIVE (MentlaMryin NNIEXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below N/A 3056401 7/1/2020 7/1/2021 X PER OTH- E.L. EACH ACCIDENT $ "1'�0r000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 A Installation Fitr 1057255 10/1/2019 10/1/2020 Limit 100,000 DESCRIPTION OF OPERATIONS (LOCATIONS / VEHICLES (ACORD 107, Additional If required by written contract, the Certificate Holder Is Included Ramarka Schedule, may be attached M more space Is required) as Additional Insured for ongoing operations under General Liability. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT10N DATE City of Fort Collins ACCORDANCE CY WITH THE POLICY OF, NOTICE ALL BE DELIVERED IN P.O. Box 580 Fort Collins, CO 80522 ©1988-2015 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD