HomeMy WebLinkAboutKJM - INSURANCE CERTIFICATEACORDL CERTIFICATE OF LIABILITY
INSURANCE
DA7E6/13/OI1310NY)
6
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Acordia Northwest, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
520 Pike Street, 20th Floor
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Seattle, WA 98101
206-701-5000
INSURERS AFFORDING COVERAGE
INSURED KJM &Associates, Ltd.
500 108th Avenue NE
INSURER A: Hartford Fire Ins. CO. A+XV
INSURERS Hartford Casualty Ins.Co A+XV
INSURER C: Hartford U/W Ins. CO. A+XV
Suite 1000
Bellevue WA 98004
INSURER D: CNA Insurance CO. A XV
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
fMM/DD/YY1
POLIDATE
TY EXPIRATION E IMMIDDIYY)
LIMITS
.LDL
B
GENERAL LIABILITY
52SBAPL7529
4/18/06
4/18/07
EACH OCCURRENCE
$ 1000000
FIRE DAMAGE (Any one fire)
$ 300000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
MED EXP (Any one person)
$ 10000
PERSONAL & ADV INJURY
$ 1000000
X STOP GAP /
EMPL. LIAB
GENERAL AGGREGATE
$ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2000000
POLICY PRO
T X LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
52UECUS0970
4/18/06
4/18/07
COMBINED SINGLE LIMIT
(Ea accident)
$ 1000000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
AUTO PHYSICAL DAM
$250 DIED COMP
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
$500 DED COLL
(INCLUDES HIRED
PROPERTY DAMAGE
(Per accident)
$
AUTOS)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGO
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
_
$
OCCUR ❑ CLAIMS MADE
$
$
DEDUCTIBLE
$
RETENTION $
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
52WECE18976
"ALL -STATES"
4/18/06
4/18/07
X ORY UM TS OTH-
ER
E.L. EACH ACCIDENT
$ 1000000
E.L. DISEASE - EA EMPLOYEE
$ 1000000
COVERAGE APPLIES
E.L. DISEASE - POLICY LIMIT
$ 1000000
D
OTHER
MCH114120080
4/18/06
4/18/07
PROFESSIONAL LIAB
CLAIMS -MADE
$2 MIL EACH CLAIM/$2 MIL AGG
RETRO DT: 10/6/90
POLICY
$50 000 DIED PER CLAIM
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
EVIDENCE OF INSURANCE REGARDING THE BOBCAT RIDGE ACCESS ROAD
IMPROVEMENTS - 80% PLAN ESTIMATING PROJECT, KJM PROJECT NUMBER
0650.0061, CONTRACT NUMBER PO 6603443. OJT
UrKIIltlL:Alt MULLI ADDITIONAL INSURED; INSURER LETTER: UANULLLA I IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN
Attn: James O'Neill, Purch. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PO Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins, CO 80522 RE -- TATIVES.
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