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HomeMy WebLinkAbout109447 INDEPENDENT SALT COMPANY - INSURANCE CERTIFICATE (2)To: City of Fort Collins From: AssurancePartners Pages: 2 Sent: 09/13/2012 16:33 Fax To: City of Fort Collins Fax: 9702216707 From: Phone: Email: Date: 9/13/2012 4:40 PM Subject: Certificate of Insurance Memo: Certificate of insurance attached for your records. To: City of Fort Collins From: AssurancePartners Pages: 2 Sent: 09/13/2012 16:33 Iiiii CERTIFICATE OF LIABILITY INSURANCE �i' DATE /13//DD/V2 9/13/2012 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 CONTACT Brenda Smith NAME: A/CNNo Ext: (800)563-1871 FAXLAIC, No:(785)825-5098 Assurance Partners 2090 S Ohio ADDRESS: bsmith@yourassurance. com PO Box 1213 PRODUCER 00000749 CUSTOMER ID #. INSURERS) AFFORDING COVERAGE NAIL# Salina KS 67402-1213 INSURED INSURERA:Federal Insurance Company 0281 Independent Salt Company INSURER B: KCI, Inc. INSURER C PO Box 36 INSURER D INSURER E Kanopolis KS 67454 INSURER F7 COVERAGES CERTIFICATE NUMBER:12/13 All Lines 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR rypE OF INSURANCEADDLSUI INSR NND POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY $[ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR 37110044 9/16/2012 9/16/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 DIED FAX (Any one person) $ 5,000 PERSONAL & ADS INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. X POLICY PER LOC JECT PRODUCTS - COMP/OPAGA $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 78389735 9/16/2012 9/16/2013 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X PODILY NJURY(Per person) $ BODILY INJURY (Per accident) $ PROPERTYAGE (Peracddent) den[) $ X X $ A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 1 79764048 9/16/2012 9/16/2013 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 DEDUCTIBLE I RETENTION $ 0 $ I X $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNEAEXECUTIVE � OFFICEAMEMBER EXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N/A WC STAT U- OTH- TORY LIM ITS ER E.L. EACH ACCIDENT $ E. L. DISEASE - EA EMPLOYE $ EL.DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins, CO is named as additional insured respecting General Liability coverage for Independent Salt Company as regards Independent Salt's product. CERTIFICATE HOLDER CANCELLATION (970) 221-6707 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins ATTN: Purchasing Division AUTHORIZED REPRESENTATIVE PO BOX 580 Fort Collins, CO 80522-0580 Leamon Bailey/LBAILE"- ACORD 25 (2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD