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HomeMy WebLinkAbout102829 DON KEHN CONSTRUCTION INC - INSURANCE CERTIFICATE (17),416. z CERTIFICATE OF LIABILITY INSURANCE 11/2/2015YY, 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 CT NAME: Dana Stewart CIC CISR NAME: PHONE No: (970)266-7149 FAX (970)506-6845 AC Flood and Peterson PO BOX 578 E-MAADREearooP IL .DStwt@fld eterson.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:C1ncinnatl Insurance Co 10677 Greeley CO 80632 INSURED INSURER B INSURERC: Don Kehn Construction Inc. INSURER D: 6550 S . County Road 5 INSURER E : INSURER F: Fort Collins CO 80528 COVERAGES CERTIFICATE NUMBER:CL1511206909 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 ADDL INSIR UBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR CPP1084111 11/1/2015 11/1/2016 DAMAGE ( RENTED PREMISESS Ea occurrence)$ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOSAUTOS PP1084111 11/1/2015 11/1/2016 Ix BODILYINJURY(Peraccident) $ HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ Medical payments $ 5,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 A EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ PP1084111 11/1/2015 11/1/2016 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If es, describe under D SCRIPTION OF nPFPATIONS below E.I_. DISEASE - POUCY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project Description: Mining Reclamation Agreement regarding Arapahoe Bend Natural Area The following are Additional Insureds as respects General Liability only if required by written contract and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. Additional Insureds: City of Fort Collins. This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract. 1113WIN Iif 10"L'm■--a: L•iR■1a.l City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 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 ACORD 25 (2010/05) INS11125 rgmnns� m Rolph, CISR/NROLPH © C ©1988-2010 ACORD CORPORATION. All rights reserved. Thn A(,np l name nnr1 Innn nrn rnnicfnrnri mnrlrc of Af'.0Pr)