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HomeMy WebLinkAboutI-KOTA INC - INSURANCE CERTIFICATEIKOTA-1 OP ID: LIZ '4�� CERTIFICATE OF LIABILITY INSURANCE DAT03/07D/YVYY) 03/07/14 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 endorsements . PRODUCER 303-799-0110 NAMEACT Ginny Shaw Cherry Creek Ins. Agency, Inc. 303-799-0156 SUlte 500 5660 Greenwood Plaza Blvd. Greenwood Village, CO 80111 Steven L. Doss PHONE 720-330-7903 ac No : 303-799-0156 NC, No Ex[: ) E-MAii ADDREss: GinnyS@thinkcci .com INSURERS) AFFORDING COVERAGE NAIL N INSURER A: Westfield Insurance 24112 INSURED I -Kota Inc 4640 Pecos Street, Unit F Denver, CO 80211 INSURER 8:PinnacolAssurance 41190 INSURERC: INSURER D INSURER E 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. EX INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS LTRINSR MD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERALLIARILITY X CMM0982161 03/10/14 03/10/15 DATA T RENTED$ PREMISES Ea occurrence 500,00 CLAIMS-MADE Ix I OCCUR MED EXP (Any one person) $ ,000 PERSONAL & ADV INJURY IS 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPECT LIES PER'. PRODUCTS - COMPIOP AGG $ 2,000,00 POLICY 11l PRO LOC $ AUTOMOBILE LIABILITY Eel ED SINGLE LIMIT accident) $ 1,000,00 BODILY INJURY (Per person) $ A X ANY AUTO CMM0982161 03/10/14 03/10/15 ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident S NON -OWNED HIREDAUTOS AUTOS $ �( UMBRELLA LIAR Xd OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A EXCESS LIAR CLAIMS -MADE CMM0982161 03/10/14 03/10/15 DED I X I RETENTION$ 01 1 Is B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED' (Mandatory in NH) (MandatoryNH) NIA 4138898 04/01/13 04/01/14 WC STATU- OTH- X TQY LIMIT$ _ E.L. EACH ACCIDENT $ 1,000,00 E. L. DISEASE -EA EMPLOYEE $ 1,000,00 DESCRIPTION OF OPERATIONS bel w E.LL DISEASE -POLICY LIMIT $ 1,000,00 C Leased/Rented IH49593693 06/25/13 06/25/14 Limit 250,000 Equipment - ACV RC BY WRITTEN CONTRACT Ded 1,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) As required by written contract or written agreement, City of Fort Collins is included as Additional Insured under General Liability. City of Fort Collins 300 LaPorte Avenue Fort Collins, CO 80521 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD