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HomeMy WebLinkAbout188139 DOHN CONSTRUCTION INC - INSURANCE CERTIFICATE (18)DOHNCON-01 LPREW A� ORD CERTIFICATE OF LIABILITY INSURANCE DATE 09/21/2017Y) 09/21 /2017 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 CONTACT NAME: PFS Insurance Group PHONE FAx 4848 Thompson Parkway Suite 200 (A/C, No, EXAM(970) 635-9400 A/C, N.): (970) 635-9401 Johnstown, CO 80534 gpMSS; info@mypfsinsurance.com INSURED Dohn Construction, Inc. DCI Residential, LLC 2642 Midpoint Drive Fort Collins, CO 80525 Assurance INSURER C:EMC Insurance Group INSURER D : INSURER F : COVERAGES CERTIFICATE NUMBER: RFVISION NIIMRFR- 2141 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 ADDLSUB TYPE OF INSURANCE INSD WVD I POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD On. DWYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS -MADE X OCCUR 1R57266 X Blanket Addl Insured _ 10/01/2017 10/01/2018 DAMAGE TO RENTED PREMISES (Ea occurrence MED EXP An one person)$ 100,000 $ 5,000 X� Blanket Waiver _ PERSONAL & ADV INJURY $ 1,000,000 $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X7 JECT LOC GENERAL AGGREGATE PRODUCTS -COMP/OPAGG $ 2,000,000 OTHER A AUTOMOBILE LIABILITY COMBINeD SINGLE LIMIT $ 1,000,000 X BODILY INJURY Per n $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 1Z57255 10/01/2017 10/01/2018 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Peraccdent $ HIRED X NON -OWNED gAUTOS ONLY AUTOS ONLY lanket Add[ Blanket Waiver Insured X X A X UMBRELLA LIAB X ' OCCUR i. EACH OCCURRENCE 10,000,000 $ EXCESSLIAB CLAIMS -MADE 1P57255 10/01/2017 10/01/2018 _ AGGREGATE _ $ 10,000,000 DED X 1 RETENTION $ 10,000 $ B . WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN ppFFICER/MEMBER EXCLUDED? ,Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA X PER OTH- STATUTE _ 3055407 07/01/2017 07/01/2018 E.L. EACH ACCIDENT EL E.L. DISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT 1,000,000 $ $ 1,000,000 __ 1,000,000 C Builders Risk A Leased/Rented Equip 1X57255 10/01/2017 10/01/2018 Any One Loc. 1057255 10/01/2017 10/01/2018 $1,000 Deductible 5,000,000 100,000 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. City of Fort Collin Purchasing Division 215 North Mason Street, 2nd Floor Fort Collins, CO 80524 191010 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 DOHNCON-01 LPREW ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYV) `—/ 09/21 /2017 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 COVERAGES CERTIFICATE NUMBER: 635-9400 nsurance.com INSU INSURER C : INSURER 0. INSURER E : FAX (A/c. Nod970)635-9401 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 TYPE OF INSURANCE AD B POLICY NUMBER POLICY EFF POLICY EXMM/DDVPY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS -MADE OCCUR X Blanket Addl Insured 1R57255 10/01/2017 10/01/2018 DAMIAGETo eE T occ;a MED EXP (Any oneperson) 100,000 51000 $ 1,000,000 $ 2,000,000 $ 2,000,000 X Blanket Waiver _ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY )C JECT LOC PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG OTHER A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ $ X ANY AUTO 1Z57255 10/01/2017 10/01/2018 BODILY INJURY Perperson) $ I� OWNED SCHEDULED I AUTOS ONLY AUTOS BODILY INJURY Per accident $ $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY AMAGE ROacER I? X Insured t Addl X Blanket Waiver $ A X UMBRELLA LIAB X OCCUR EXCESS LIAB _ CLAIMS -MADE FJDED X RETENTION $ 10,000' 1P57255 10/0112017I 10/01/2018 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 B WORKERS COMPENSATIONAND EMPLOYERS' - ANY PROPRIETOR/PAPARTRTNNERER /EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 3055407 07/01/2017 07/01/2018 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE $ 1,000,000 $ 11000,000 Byes. describe under DESCRIPTION OF OPERATIONS below . E.L. DISEASE - POLICY LIMIT 1,000,000 A Installation 1057255 10/01/2017 10/01/2018 $1,000 Deductible 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) If required by written agreement, the certificate holder is included as additional insured for ongoing operations under general liability. to] :I:iI17CeI_1m0l, City of Fort Collins 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD