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HomeMy WebLinkAboutKILLION ENTERPRISES LLC - INSURANCE CERTIFICATE (2)From:Debbie Livermore FaxID:Western States Insur Page 2 of 3 Date:10/2712009 02:06 PM Page:2 of 3 R& CERTIFICATE OF LIABILITY INSURANCE OP ID 5D KILLI-2 DATE(MM/DD/YYYY) 10/27/09 PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Western States Ins'- Bozeman HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1283 N. 14th Ave, Ste 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV Bozeman MT 59715 Phone: 406-586-3351 Fax:406-586-0437 INSURERS AFFORDING COVERAGE NAIC # INSURED IN SURER A'. Mid Continent Casualty INSURER B: Killion Enterprises LLC Jamie Jamie IN INSURER D: 730 Jason Lane Fort Collins CO 80524 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 W ITH 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X X COMMERCIAL GENERAL LIABILITY 04GL000712233 03/11/09 03/11/10 PREMISES (Eaoccurence) $ 100,000 CLAIMS MADE F OCCUR MED EXP (Any one person) $ Excluded PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMfi APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO- JECT ` AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Pe r acci dent) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AN Y AUTO AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE ;$ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION WC STATU- 0 H- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER I E.L. EACH ACCIDENT $ ANY PRO PR IETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? E.L. DISEASE -EA EMPLOYE $ (Mandatory in NH) If yes. describe under , E.L. DISEASE -POLICY LIMIT '$ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is additional insured in respect to General Liability III I IrIGA I C MULUCK GANGELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITYFCI DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR PO Box 580 REPRESENTATIVES. Fort Collins CO 80522 AuRIZED�TaT ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From:Debbie Livermore FaxID:Western States Insur Page 3 of 3 Date:10/27/2009 02:06 PM Page:3 of 3 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.