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HomeMy WebLinkAbout103118 KWALL-HOWELLS INC - INSURANCE CERTIFICATEACiORV CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDWYY) 2/14/2014 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). Fiy FaunC [ roup, Inc. - Cleveland 6000 Freedom Square Drive Suite 400 Cleveland, OH 44131 NAME:CONTACT Sall Harper FAX PHONE 216-447-1050 (AM No): 216-447-4088 E-MAIL D Sall .Ha r H lant.com INSURERS AFFORDING COVERAGE NAIC i INSURER A :National Union File Insurance Co. of Pittsburgk PA 19445 INSURED ©� Kwal-Howells, Inc. lXi INSURER B : INSURERC:Qualified Self Insurance INSURER D:Safety National Casualty Corp. 15105 5575 DTC Parkway, Suite 100 INSURERE: Englewood, CO 80111 C T-1 INSURER F : COVERAGES CFRTIFICATF NIIMRFR- RF\/ICIOM NI IAARFR- 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF M DDM' POLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GL5094663 12/16/13 05/01/16 /01/16 EACH OCCURRENCE S VREMSEs ERE«cMrence S 1,000,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JET LOC I PRODUCTS - COMPIOP AGG s 1,000,000 1,000,000X A A A AUTOMOBILE LIABILITY ANY AUTO ADDS NED SCHEDULED AUTOS HIRED AUTOS X NON -OWNED AUTOS CA5196415 (AOS) CA5196416 (MA) CA5196417 (VA) 12/16/13 112/16/13 12/16/13 05/01/16 05/01/16 05/01/16 EaOMBBINEeD SINGLE LIMIT 1,000,000 X BODILY INJURY (Pat person) f X BODILY INJURY (Pat accklent) s X PROPERTY DAMAGE Per accident f S UMBRELLA UAB EXCESS LIAR H OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION f EA OCC PROD/COMP OP s D D G. WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N❑ OFFICER/MEMBER EXCLUDED? (Mandatary in NH) a describe under DESCRIPTION OF OPERATIONS below NIA LDS4041894 PS4041895 SELF INSURED (SEE DESC.) 01/01/14 01/01/14 05/01/14 05/01/14 WCSTATU- OTH- E.LEACHACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEd $ 1,000,000 E.L. DISEASE - POLICY LIMIT f 1,000,Q00 D EXCESS WORKERS' COMP EMPLOYERS LIAB SP4048477 (AOS) SP4048478 (FL) 1/01/14 1/01/14 5/01/14 5/01/14 WC STATUTORY D EMPLOYERS LIAB 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ALL LOCATIONS AND OPERATIONS OF THE NAMED INSURED AND ITS DIVISIONS IN ALL STATES The City, Its Officers, Agents And Employees Is An Additional Insured As Respects General Liability Coverage, Only As Required By Contract, Subject To The Terms And Conditions Of The Policy. lR�cur,arppLi.lO4liG. City of Fort Collins Attn: Purchasing and Risk PO 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 M" V 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD INSURED Kwal-Howells, Inc. OF NAMED INSUREDS NORTH AMERICA, INC. F/K/A COMEX GROUP, INC. GROUP, INC. FESSIONAL PAINT, INC. !EE INDUSTRIES HOLDINGS, INC. 'EE INDUSTRIES, INC. L-HOWELLS HOLDINGS, INC. L-HOWELLS, INC. (ER PAINT HOLDINGS, INC. (ER PAINT MFG, CO., INC. CEE FRANCHISE CORP. -LAR PAINT (DBA) HIR MORRIS HOLDINGS, INC. ACQUISITION CORP. SOPHIR COMPANY -LAR KWAL PAINT (DBA) -LAR ACQUISITION CORP. -LAR HOLDINGS, INC. KBACK ACQUISITION CORP. KBACK PRODUCTS (DBA) KBACK HOLDINGS, INC. 3SIC PAINT (DBA) L PAINT (DBA) ,L PAINTS (DBA) EX USA, INC. fDERHORN ACQUISITION CORP. -LAR ACQUISITIONS DBA AMERIMEX PAINT CENTERS DR WHEEL PAINT MFG. CO., INC. DR WHEEL PAINTS AND COATINGS DR WHEEL PAINTS PAINT STORE WHEEL DECORATING CENTER PROPERTIES, LTD. HOLDINGS, INC. WHEEL ACQUISITION CORP. WHEEL HOLDINGS, INC. GROUP IP. INC. AEX ENVIRONMENTAL GROUP, INC. RESPECTS PRODUCTS SOLD IN THE UNITED STATES CERTIFICATE HOLDER: DATE 2/14/2014 A400 CERTIFICATE OF LIABILITY INSURANCE z/14/2014�' 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). H Ianl tiroup, Inc. - Cleveland 6000 Freedom Square Drive Suite 400 Cleveland, OH 44131 cONT Sall Har r PNAPcT HONE FAX 216-447-1050 No), 216- 47-4088 EAp AIL Sally. Har H ant.com INSURERS AFFORDING COVERAGE NAIL � INSURER A :National Union Fire Insurance Co. of Pittsburgh, PA 19445 INSURED INSURER 0 : INSURERC:Qualified Self Insurance Kwal-Howells, Inc. INSURER D:Safety National Casualty Corp. 15105 5575 DTC Parkway, Suite 100 INSURER E: Englewood, CO 80111 C T-1 INSURER F : COVERAGES CERTIFICATE NUMBER: 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 LTR 7ypE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF POLICY D EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR I GL5094663 IGL5094664 12/16/13 12/16/13 05/01/16 05/01 /16 EACH OCCURRENCE f 1,000,000 PREMISES (Eat occurrence) $ 1,000, 00 MED EXP( we ) $ PERSONAL 6 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: X I POLICY JPE'CT LOc PRODUCTS - COMPIOP AGG S 1,000,000 1 EA OCC PROD-COMP/OP $ 1,000,000 A A A AUTOMOBILE LIABILITY X ANY AUTO X AUL0OWNED SCHEDULED AUTOS X HIRED AUTOS NON -OWNED AUTOS CA5196415 (AOS) CA5196416 (MA) CA5196417 (VA) 12/16/13 12/16/13 12/16/13 05/01/16 05/01/16 05/01/16 10EOMaBIINIEDISINGLE LIMIT 1,000,000 BODILY INJURY (Pat person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE as $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED RETENTION S EA OCC PROD/COMP OP $ D D C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNER/EXECUTIVE� OFFICER/MEMBER EXCLUDED? (Myaandatory in NH) DESCbe under RIPTION OF OPERATIONS below NIA LDS4041894 PS4041895 ISELF INSURED (SEE DESC.) 01/01/14 01/01/14 05/01/14 05/01/14 X I WC STATTORY U- OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE S 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D EXCESS WORKERS' COMP EMPLOYERS LIAB SP4048477 (AOS) SP4048478(FL) 1/01/14 1/01/14 5/01/14 5/01/14 WC STATUTORY ANDEMPLOYERS LIAB 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ALL LOCATIONS AND OPERATIONS OF THE NAMED INSURED AND ITS DIVISIONS IN ALL STATES City Of Fort Collins Is Additional Insured As Respects General Liability Where Required By Written Contract. Term Has Been Extended From April 15, 2011 Through April 14, 2012. City of Fort Collins Attn: Director of Purchasing and Risk Management PO Box 580 Fort Collins CO 85022 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 y- ® 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD INSURED Kwal-Howells, Inc. OF NAMED INSUREDS NORTH AMERICA, INC. F/K/A COMEX GROUP, INC. GROUP. INC. �FESSIONAL PAINT, INC. ZEE INDUSTRIES HOLDINGS, INC. ZEE INDUSTRIES, INC. �L-HOWELLS HOLDINGS, INC. �L-HOWELLS, INC. KER PAINT HOLDINGS, INC. KER PAINT MFG. CO., INC. ZEE FRANCHISE CORP. LLAR PAINT (DBA) 'HIR MORRIS HOLDINGS, INC. ACQUISITION CORP. SOPHIR COMPANY LLAR KWAL PAINT (DBA) LLAR ACQUISITION CORP. AR HOLDINGS, INC. 3ACK ACQUISITION CORP. 3ACK PRODUCTS (DBA) 3ACK HOLDINGS, INC. ;IC PAINT (DBA) PAINT (DBA) PAINTS (DBA) X USA, INC. ERHORN ACQUISITION CORP. AR ACQUISITIONS DBA AMERIMEX PAINT CENTERS 2 WHEEL PAINT MFG. CO., INC. 2 WHEEL PAINTS AND COATINGS DR WHEEL PAINTS PAINT STORE DR WHEEL DECORATING CENTER UBE PROPERTIES, LTD. UBE HOLDINGS, INC. OR WHEEL ACQUISITION CORP. OR WHEEL HOLDINGS, INC. lEX GROUP IP, INC. 7EX ENVIRONMENTAL GROUP, INC. RESPECTS PRODUCTS SOLD IN THE UNITED STATES CERTIFICATE HOLDER: DATE 2/14/2014 A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIY 2/14/2014vvv) 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). Pnorabroup, Inc. - Cleveland 200 Freedom Square Drive Suite 400 Cleveland, OH 44131 CONTACT Sall Har r PHONE FAX -4471t088 216-447-1050 AIC No:216EMA A 6DRLESS: Sally. Har H ant.com INSURER S AFFORDING COVERAGE NAIL t INSURER A :National Union Fire Insurance Co. of Pittsburgh, PA 19445 INSURED INSURER B : INSURERC:Qualified Self Insurance Kwal-Howells, Inc. 5575 DTC Parkway, Suite 100 INSURER D:Safety National Casualty Corp. 15105 INSURER E: Englewood, CO 80111 C T 1 INSURER F : r n%1rDAr_FC f FDTIFICATF NI IMRFR• RFVISInN NIIMRFR- 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 LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER PM/DDIYYYY LICY EFF POLICY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLMMS-MADE IR-1 OCCUR GL5094663 GL5094664 12/16/13 12/16/13 05/01/16 05/01/16 EACH OCCURRENCE S 1,000,000 AGE TO RENTED PREMISES Me occurrence) f 1,000,000 MED EXP (Any one person) f PERSONAL &ADV INJURY f 1,000,000 GENERAL AGGREGATE f 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: X Poucv PROJECT F7 LOC PRODUCTS-COMPIOP AGG f 1,000,000 EAOCCPROD-COMP/OP f 1,000,000 A A A AUTOMOBILE LIABILITY X ANYAUTO AALL UTOS OWNED SIC UTOSULED X HIRED AUTOS NON -OWNED AUTOS CA5196415 (AOS) CA5196416 (MA) CA5196417 (VA) 12/16/13 12/16/13 12/16/13 05/01/16 05/01/16 05/01/16 Ea accliidentSINGLE LIMIT 11000,000 BODILY INJURY (Per person) f BODILY INJURY (Per accident) f PROPERTY DAMAGE Per accitlern f S UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE f AGGREGATE S DIED RETENTION f EA OCC PROD/COMP OP f D D G. WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Q OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If s, tlesaibe under DESCRIPTION OF OPERATIONS below N/A LDS4041894 PS4041895 SELF INSURED (SEE DESC.) 01/01/14 01/01/14 05/01/14 05/01/14 X I WC STATU- OTH- DRYAND E.L. EACH ACCIDENT f 1,000,000 E.L. DISEASE - EA EMPLOYE f 1,000,000 E.L. oisEASE - POLICY LIMIT f 1 ,000,000 D 1 EXCESS WORKERS' COMP EMPLOYERS LIAB SP4048477 (AOS) SP4048478 (FL) 1/01114 1/01/14 5/01/14 5/01/14 WC STATUTORY ND EMPLOYERS LIAB 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ALL LOCATIONS AND OPERATIONS OF THE NAMED INSURED AND ITS DIVISIONS IN ALL STATES The City Of Fort Collins Is An Additional Insured As Their Interest May Appear As Respects General Liability Where Required By Written Contract. City of Fort Collins Attn: John Stephen, CPPB, Senior Buyer PO Box 580 215 North Mason Street, 2nd Floor Fort Collins CO 80522-0580 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 M:e-z'1,�-1 V 1988-2010 ACURD CURPURA I IUN. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD INSURED Kwal-Howells, Inc. OF NAMED INSUREDS MEX NORTH AMERICA, INC. F/K/A COMEX GROUP, INC. MEX GROUP, INC. OFESSIONAL PAINT, INC. AZEE INDUSTRIES HOLDINGS, INC. AZEE INDUSTRIES, INC. IAL-HOWELLS HOLDINGS, INC. (AL-HOWELLS, INC. RKER PAINT HOLDINGS, INC. RKER PAINT MFG. CO., INC. AZEE FRANCHISE CORP. ELLAR PAINT (DBA) PHIR MORRIS HOLDINGS, INC. IC ACQUISITION CORP. E SOPHIR COMPANY ELLAR KWAL PAINT (DBA) ELLAR ACQUISITION CORP. ELLAR HOLDINGS, INC. CKBACK ACQUISITION CORP. CKBACK PRODUCTS (DBA) CKBACK HOLDINGS, INC. ASSIC PAINT (DBA) IAL PAINT (DBA) !AL PAINTS (DBA) ,MEX USA, INC. WDERHORN ACQUISITION CORP. ELLAR ACQUISITIONS DBA AMERIMEX PAINT CENTERS LOR WHEEL PAINT MFG. CO., INC. LOR WHEEL PAINTS AND COATINGS LOR WHEEL PAINTS E PAINT STORE LOR WHEEL DECORATING CENTER RUBE PROPERTIES, LTD. RUBE HOLDINGS, INC. LOR WHEEL ACQUISITION CORP. LOR WHEEL HOLDINGS, INC. iMEX GROUP IP, INC. ,MEX ENVIRONMENTAL GROUP, INC. i RESPECTS PRODUCTS SOLD IN THE UNITED STATES CERTIFICATE HOLDER: DATE 2/14/2014 CERTIFICATE OF LIABILITY INSURANCE I DATE DD/YVVV) 2/14/2014 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). yyGianflGroup, Inc. - Cleveland 6000 Freedom Square Drive Suite 400 Cleveland, OH 44131 INSURED Kwal-Howells, Inc. 5575 DTC Parkway, Suite 100 Englewood, CO 80111 C T-1 PA rOVFRAGFS CERTIFICATE NUMBER: REVISION NUMBER: 21 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. LT ILT TYPE OF INSURANCE INgRADDL SUBR POLICY NUMBER POLICY F POLICY P LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IX-1 OCCUR GL5094663 GL5094664 12/16/13 12/16/13 05/01/16 05/01/16 EACH OCCURRENCE S 1,000,000 DAMAG PREMISES (Eaoccurrence)s 11000,000 MED EXP (Any one arson) f PERSONAL & ADV INJURY f ,000,000 GENERAL AGGREGATE f 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY PROJFCT Loc PRODUCTS - COMP/OP AGG f 1,000,000 EAoCCPROD-COMP/OP f 1,000,000 A A A AUTOMOBILE LIABILITY X ANY AUTO AALLOOWNED SCHEDULED S AUTOS X HIRED AUTOS X NON -OWNED AUTOS CA5196415(AOS) CA5196416 (MA) CA5196417 (VA) 12/16/13 12/16/13 12/16/13 05/01/16 05/01/16 05/01/16 OM�BBIINEDISINGLE LIMIT 1000000 BODILY INJURY (Per person) f BODILY INJURY (Per accident) f PROPERTYAGE f f UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE f AGGREGATE f DIED RETENTION f EA OCC PROD/COMP OP f D D C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N❑ (Mandatory in NH) Byes dasrnbe°"der DESCRIPTION OF OPERATIONS below N / A LDS4041894 PS4041895 SELF INSURED SEE DESC. ( ) 01/01/14 05/01/14 01/01/14 '05/01/14 X I WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT f 1,000,000 E.L. DISEASE - EA EMPLOYE f 1,000,000 E.L. DISEASE - POLICY LIMIT f 1,000,000 D EXCESS WORKERS' COMP EMPLOYERS LIAB SP4048477 (AOS) SP4048478 (FL) 1/01/14 1101/14 5/01/14 5/01/14 WC STATUTORY ANDEMPLOYERS LIAB 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is re ulrod) ALL LOCATIONS AND OPERATIONS OF THE NAMED INSURED AND ITS DPISMONS IN ALL STATES Re: Renewal, 6043 Mapo Athletic Field Paint. Certificate Holder Is Additional Insured As Respects General Liability Where Required By Written Contract. C'FRTIFIC'ATF HOI nFR CANCELLATION 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 215 North Mason Street, 2nd Floor AUTHORIZED REPRESENTATIVE PO Box 580 Fort Collins CO 80522-0580 C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD INSURED Kwal-Howells. Inc. DOLE OF NAMED INSUREDS 1EX NORTH AMERICA, INC. F/K/A COMEX GROUP, INC. 1EX GROUP, INC. FESSIONAL PAINT, INC. ZEE INDUSTRIES HOLDINGS, INC. ZEE INDUSTRIES, INC. �L-HOWELLS HOLDINGS, INC. &-HOWELLS, INC. KER PAINT HOLDINGS, INC. KER PAINT MFG. CO., INC. ZEE FRANCHISE CORP. LLAR PAINT (DBA) 'HIR MORRIS HOLDINGS, INC. ACQUISITION CORP. SOPHIR COMPANY LLAR KWAL PAINT (DBA) LLAR ACQUISITION CORP. LLAR HOLDINGS, INC. 'KBACK ACQUISITION CORP. KBACK PRODUCTS (DBA) KBACK HOLDINGS, INC. SSIC PAINT (DBA) kL PAINT (DBA) \L PAINTS (DBA) 7EX USA, INC. ✓DERHORN ACQUISITION CORP. LLAR ACQUISITIONS DBA AMERIMEX PAINT CENTERS OR WHEEL PAINT MFG. CO., INC. OR WHEEL PAINTS AND COATINGS OR WHEEL PAINTS PAINT STORE OR WHEEL DECORATING CENTER UBE PROPERTIES, LTD. UBE HOLDINGS, INC. OR WHEEL ACQUISITION CORP. OR WHEEL HOLDINGS, INC. 7EX GROUP IP, INC. 7EX ENVIRONMENTAL GROUP, INC. RESPECTS PRODUCTS SOLD IN THE UNITED STATES CERTIFICATE HOLDER: DATE 2/14/2014