Loading...
HomeMy WebLinkAbout188139 DOHN CONSTRUCTION INC - INSURANCE CERTIFICATE (16)DOHNCON-01 RCAMPBELL '4Ci�R�N CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/29/2015 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 is an ADDITIONAL INSURED, the policy(ies) must 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 endorsement(s). PRODUCER CONTACT NAME: PFS Insurance Group PHONE FAX 4848 Thompson Parkway Suite 200 A/C No Ext : (970) 635-9400 vc, No): (970) 635-9401 Johnstown, CO 80534 ADDRess: info@mypfsinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURED Dohn Construction, Inc. DCI Residential, LLC DCI Residential, LLC 2642 Midpoint Drive Fort Collins, CO 80525 INSURER A: Employers Mutual Casualty Co INSURER B : Pinnacol Assurance Co 41190 INSURER c : EMC Insurance Companies 21415 INSURER D : INSURER E : INSURER F : CDVFRAGFS CFRTIFICATF NIIMRFR- RFVISION 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 LTR TYPE OF INSURANCE DDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE TOCCUR 1R57255 10/01/2015 10/01/2016 DAMAGE TO RENT PREMISES Ea occurrence $ 100,000 X MED EXP (Any one person) $ 5,000 Blkt Add'I Insured X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � PEC LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMEaBINEDaccident SINGLE LIMIT $ 1,000,000 , A X ANY AUTO 1Z57255 10/01/2015 10/01/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED X HIRED AUTOS X AUTOS PROPcci-Z ERTY DAMAGE Pe ra $ $ X Blkt Add-1 Insured X Blkt Waiver of Subro UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 3055407 07/01/2015 07/01/2016 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 C Builders Risk 1X57255 10/01/2015 10/01/2016 One Loc. 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: 7637 General Contractor for Fire Station Expansion & Renovation Projects. If required by written contract or written agreement the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder is included as Additional Insured for ongoing & completed operations under General Liability. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Financial Services Purchasing Division 215 N. Mason Street 2nd Floor Fort Collins, CO 80524 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD DOHNCON-01 RCAMPBELL ACOROW CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 912912015 015 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 is an ADDITIONAL INSURED, the policy(ies) must 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 endorsement(s). PRODUCER CONTACT NAME: PFS Insurance Group PHONE 970 635-9400 FAX 970 635-9401 4848 Thompson Parkway Suite 200 A/C No Ext : ( ) (A/C, No): ( ) Johnstown, CO 80534 E-MAIL 4-MAIL, , info(a)mvpfsinsUrance.com INSURED Dohn Construction, Inc. DCI Residential, LLC DCI Residential, LLC 2642 Midpoint Drive Fort Collins, CO 80525 INSURER(S) AFFORDING COVERAGE INSURER A: Employers Mutual Casualty Co INSURER B : Pinnacol Assurance Co INSURER C : EMC Insurance Companies INSURER E : INSURER F : COVERAGES CERTIFICATF NIIMRFR- REVISION NIIMRFR- 41190 21415 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 LTR TYPE OF INSURANCE D INSD R WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR 1R57255 10/01/2015 10/01/2016 PAMA Eib REMISES Ea occurrence)$ 100,000 X Blkt Add'1 Insured MED EXP (Any one person) $ 5,000 X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � PE� LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO 1Z57255 10/01/2015 10/01/2016 ALL OWNED SCHEDULED ! AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS X NON -OWNED AUTOS X PROPERTY DAMAGE P.OFccident $ �( Blkt Add'I Insured XukbWaiver of $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAB CLAIMS -MADE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A 3055407 07/01/2015 07/01/2016 SPER OTH- TATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000,000 C Builders Risk 1X57255 10/01/2015 10/01/2016 One Loc. 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Poudre Fire Authority Facilities in Fort Collins. If required by written contract or written agreement the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder is included as Additional Insured for ongoing and completed operations under General Liability. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Financial Services Purchasing Division 215 N. Mason St. 2nd Floor Fort Collins, CO 80524 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 Z41-- @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD DOHNCON-01 RCAMPBELL ,d►coRL7" CERTIFICATE OF LIABILITY INSURANCE DAT D/YYYY) 9/29/229/2015 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 is an ADDITIONAL INSURED, the policy(ies) must 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 endorsement(s). PRODUCER CONTACT NAME: PFS Insurance Group 4848 Thompson Parkway Suite 200(AC, PHONE FAX Ac No Eld : (970) 635-9400 A/c No : (970) 635-9401 Johnstown, CO 80534 A DRESS: info@mypfsinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Employers Mutual Casualty Co INSURED INSURER B : Plnnacol Assurance Co 41190 Dohn Construction, Inc. DCI Residential, LLC INSURER C : DCI Residential, LLC 2642 Midpoint Drive INSURERD: Fort Collins, CO 80525 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION 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 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 A DL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX I OCCUR Blkt Add'I Insured 1R57255 10/01/2015 10/01/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT PREMISES Ea occurrence $ 100,000 X ME EXP (Any one person) $ 5,000 X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � PE� LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS AUTOS Blkt Add] Insured X Blkt Waiver of Subro 1Z57255 10/01/2015 10/01/2016 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ X $ A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE 1P57255 10/01/2015 10/01/2016 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED I X I RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 3055407 07/01/2015 07/01/2016 PER OTH- STATUTE ER E.L. EACH ACCIDENT __ $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Service Contract. If required by written contract or written agreement, The City of Fort Collins is included as additional insured for ongoing operations and completed operations under general liability. CERTIFICATE HOLDER CANCELLATION City of Fort Collins City's Director of Purchasing & Risk Management 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. AUTHORIZED REPRESENTATIVE �Jlu" © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD