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Home My WebLink About188139 DOHN CONSTRUCTION INC - INSURANCE CERTIFICATE (19)DOHNCON-01 LPREW ACORO DATE (MM/DD/YYYY) �, CERTIFICATE OF LIABILITY INSURANCE 06/14/2018 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 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 endorsement(s). PRODUCER PFS Insurance Group 4848 Thompson Parkway Suite 200 Johnstown, CO 80534 INSURED Dohn Construction, Inc. DCI Residential, LLC 2642 Midpoint Drive Fort Collins, CO 80525 635-9400 635-9401 INSURERA:Employers Mutual Casualty Compariv 21415 ' INSURER B : Pinnacol Assurance Co 41190 INSURER C:EMC Insurance Group 21415 INSURER D : INSURER E : INSURER F : rnvl=Rerl=c C-ERT!F!C-ATE NUMBER* REVISION NUMBER: v THIS IS TOCERTIFYTHAT 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, T HE 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 LTRA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR 1R57255 10/01/2017 10/01/2018 DAMAGE5( RENTED PREMI E Ea occurrence)$ 100,000 Blanket Addl Insured X MED EXP (Any oneperson) $ 5,000 X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � PE� LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY COaBcaeDtSINGLE LIMIT (EaX $ 1,000,000 BODILY INJURY Perperson) $ ANY AUTO 1Z57255 10/01/2017 10/01/2018 BODILY INJURY Per accident $ OWNED I SCHEDULED AUTOS ONLY AUTOS X AUTOS ONLY X A�TOS ONE Blanket Addl Blanket Waiver X Insured X PerOacctleMDAMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS -MADE 1P57255 10/01/2017 10/01/2018 AGGREGATE $ 10,000,000 DED I X I RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYPRR MEMBER/EXCLUDED? ECUTIVE ❑ in (Mandatory NH) N / A 3055407 07/01/2018 07/01/2019 X PEATUTE ERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L.. DISEASE POLICY LIMIT: 1,000,000 $ If yes. describe under DESCRIPTION OF OPERATIONS below C Builders Risk 1X57255 10/01/2017 10/01/2018 Any One Loc. 5,000,000 A Leased/Rented Equip 1057255 10/01/201710/01/2018 $1,000 Deductible 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: City of Fort Collins Proposal No. 8546. If required by written contract the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder is named as Additional Insured for ongoing operations and completed operations on a Primary and Non -Contributory basis under General Liability and Automobile Liability. If required by written contract, a Waiver of Subrogation in favor of the Certificate Holder applies to the General Liability, Automobile Liability and Workers' Compensation. Umbrella provides excess coverage over the General Liability, Automobile Liability and Employers' Liability. 1111191:1V City of Fort Collin Purchasing Division 215 North 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD