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HomeMy WebLinkAboutCOKAN ENTERPRISES INC - INSURANCE CERTIFICATE"`' Uri V, CERTIFICATE OF LIABILITY INSURANCE DATE nAMIDD/VYYY) 06/30/2014 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). PRODUCER Insurance Planning, Inc. 3006 Broadway Avenue P. 0. Box 100 Hays, KS 67601 NTA NAME: Kathy Casper PMNIE Ex:785.625.5605 No:78S.625.8388 A DRESS: PRODUCER CUBT MER ID e: INSURER(S) AFFORDING COVERAGE NAICI INSURED CoKan Enterprises Inc. 13831 County Line Road 22 Lupton, CO 80621 INSURER A: Berkley Regional Specialty Ins INSURER B: United Fire & Casualty 13021 INSURERC: INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 14/15 Certlticates 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 ADDL SUBa WVD POLICY NUMBED POLICY EFF MMA) POLICY EXP MMID LIMITS A GENERAL LIABILDY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CGL00434172 06/27/2014 06/27/2015 EACH OCCURRENCE $ 2,000,00 DAMAGE TO RENTEDPREn $ lOO, OO MED EXP(My one person) $ 1,00 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- L� ECT El PRODUCTS - COMP/OP AGO $ 2,000,00 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 6041629 06/27/2014 06/27/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000 , 00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccident) $ X X $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y/N OFFICER/ME BER EXCLUDED? ANY ECUTIVEF (Mandatory In NH) Use, describe under DESCRIPTION OF OPERATIONSWI" N/A I I WC $TATU- DTH- RY MIT H E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ B Leased or rented equipmen 6041629 06/27/2014 06/27/2015 $100,000 Limit DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AHxh ACORD 101, Addidonel Remarks Schedule, H more spew Is required) FAX: 970.224.6134 City of Fort Collins PO Box S80 Fort Collins, CO 8OS26 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 (2009/09) 1988-2009 ACORD CORPORATION. All The ACORD name and logo are registered marks of ACORD reserved. ACORQ AGENCY CUSTOMER ID: LOC s: ADDITIONAL REMARKS SCHEDULE Page Of AGENCY Insurance Planning, Inc. NAMED INSURED Col(an Enterprises Inc. Lupton, CO 80621 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:ACOB) Certificate of Liability Insurance Garage Liability INSR ADD-L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE(MMIDDNY) DATE(MM01D ) LIMITS AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ Automobile Liability INSR ADD-L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE (MWDD/YY) DATE (MMMMY) B Excess/Umbrella Liability INSR ADDIL POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE (MMATDIYY) DATE (MMIDWY) LIMITS Other Liability INSR POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE (MMMINVY) DATE (MMA)DIYY) LIMN$ B The ACORD name and logo are registered marks of ACORD A�� b® CERTIFICATE OF LIABILITY INSURANCE 6/2�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(les) 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 NAME: Pat Martine PHONE U, (303)420-4766 FAX (303)431-4634 Stolte Insurance Agency 7707 Ralston Rd AEMA`6DRLEs,.pat@stolteins.com P O Box 664 INSURERS AFFORDING COVERAGE NAIC N INSURER A:Plnnacol Assurance Arvada CO 80001 INSURED INSURER B INSURERC: COKan Enterprises Inc. INSURER D: 13831 County Road 22 INSURER E : 1 INSURER F: Fort Lupton CO 80621 COVERAGES CERTIFICATE NUMBER:07/14-15 REVISION NLIMRFR- 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 ADDL5UBR POLICY NUMBER POLICY EFF / POLICY UP MM LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLNMS-MADE OCCUR EACH OCCURRENCE $ AMA RENT PREMI Ea ME once E MED EXP we m) $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE POLICY LIMIT APPLIES PER PRO LOC PRODUCTS - COMP/OP AGG E $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT Ea accitlen BODILY INJURY (Per person) $ BODILY INJURY (Par accident) ) $ PROPERTY DAMAGE Per sock) nl $ E UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMSi E EACH OCCURRENCE $ AGGREGATE $ LIED I I RE I $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) it yea, m desbe under DESCRIPTION OF OPERATIONS below NIA 157395 /1/2014 /1/2015 - X I WC STATIU OTH- LIMANY E.L. FACH ACCIDENT E 1 D00 00O E. L. DISEASE -EA EMPLOYE E 1 000 000 E.L. DI$EA$E- POLICY LIMIT 1 E 1.000.00 T DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, IF mom space Is required) (970)224-6134 City of Fort Collins PO Box 580 Fort Collins, CO 80526 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 (2010105) Martine/PAT �1--:� �i ©1988-2010 ACORD CORPORATION. All rights reserved. Inouca (zuluw)Ul The ACORD name and logo are registered marks of ACORD