HomeMy WebLinkAboutKYTO INC - INSURANCE CERTIFICATE (2)Pharmacists AK
MutualeCompInsurance
y Solutions
800.247.5930 or 515.295.2461 • P.O. Box 370, 808 Highway 18 West, Algona, Iowa 50511-0370
SPECIAL BUSINESSOWNERS DECLARATIONS
THIS IS NOT A BILL
NAMED INSURED AND MAILING ADDRESS CUSTOMER NUMBER 0006755901
KYTO INC POLICY NUMBER BOP 0089544 08
MOBILITY AND MORE Previous Policy Number BOP 0089544
493 N DENVER AVE LOVELAND CO 80537 POLICY PERIOD 07/01/14 TO 07/01/15
12 01 A.M. Local Time at the described location
.... _...
TRANSACTION
AMENDED DECLARATION Effective: 07/15/14
ADD ADD'L INTEREST
INSUREDIS: Corporation (C) BUSINESS OF INSURED: Home Medical Equipment
In return for payment of the premium, and subject to all terms of this policy, we agree with you to provide the
insurance as stated in this policy.
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LIABILITY COVERAGE:
GENERAL AGGREGATE LIMIT
PRODUCTS/COMPLETED WORK HAZARD AGGREGATE LIMIT
EACH OCCURRENCE LIMIT
Products/Completed Work Hazard Liability
Personal and Advertising Injury Liability
Home Health Care Services Consultation Liability
FIRE LEGAL LIABILITY LIMIT (per occurrence)
WATER LEGAL LIABILITY (per occurrence)
MEDICAL PAYMENTS LIMIT (per person)
LIMIT
2.000.000
2,000,000
i�[rISI�)[HHrI
Included
Included
Included
zs0,000
50,000
5,000
'1 R,1Till n L1 c.LLrIf
Additional Premium 11.00 AMENDED POLICY PREMIUM TOTAL $1,746.00
WARNING: A person who knowingly submits an application or files a claim with intent to defraud or helps commit a fraud against
an insurer may be guilty of a crime and may be subject to criminal and civil penalties.
Authorized Representative THOMAS A. QUESENBERY, CPCU 4040
BDPDEC Date Printed:07/16/14 ADD'L INSURED COPY Page 1 of 3
Pharmacists
InsuMutual°Comp'
NAMED INSURED KYTO INC
POLICY PERIOD 07/01/14 TO 07/01/15
FORMS AND ENDORSEMENTS
ACORD25 (01/14) Certificate of Liability Ins
BP0336 (01/04) Premium Payments
BP0686 (06/12) Amendatory Endorsement CO
BP0734 (01/04) Lead Liability Exclusions
BP0738 (06/12) AI -Newly Acquired Organization
BP0750 (01/08) Certified Terrorism Loss
BP0039 (10/05) Asbestos Exclusion
BPO868 (06/12) Cross Liab Exc-Inj Certain Ins
CLO605 (01/08) Certified Terrorism Loss Discl
CL1045NSFP(01/08) Notice of Terrorism Coverage
PM1093B (05/13) HHC Consultation Services Liab
PM1114B (06/05) Employee Redefined
PM1142B (05/13) Water Legal Liability Coverage
PM9816 (05/13) Data Compromise Renewal Letter
POLICY INTERESTS
Loc. ADDITIONAL INSURED
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS CO 80522
Loc.l CERT HOLDER/ADDITIONAL INSR'D
PRAIRIE VIEW INDUSTRIES
PO BOX 575
FAIRBURY NE 68352
InsurN nceSOl Ution
CUSTOMER # 0006755901 POLICY # BOP 0089544 08
12 01 A.M. Local Time at the described location
BP0200
(06/12)
Businessowners Special Policy
BPO676
(06/12)
Excl-Fungus or Related Perils
BP0722
(01/04)
Punitive Damages Exclusion
BP0736
(01/04)
Exclusion -Abuse or Molestation
BP0748
(06/12)
Total Pollution Exclusion
BP0753
(01/04)
Amend Definition Cov Contract
BPO841
(10/05)
AI -Designated Person/Organiz.
BP1780
(06/06)
Conditional Terrorism Excl
CL0682
(06/13)
Civil Unions Amendment CO
PM1000
(09/12)
Mutual Company Provisions
PM1103B
(05/13)
Equipment Breakdown Enders.
PM1135B
(05/13)
Property Plus Coverages
PM1153
(05/13)
Duty to Defend Ends w/Tendered
PM9987B
(05/13)
Discl Notice -Spec Pol/End Chgs
Loc.l CERT HOLDER/ADDITIONAL INSR'D
ACCESS4U INC
601 BERKSHIRE DR
PITTSBURGH PA 15215
'14AIL 21 11;22,q
BOPDEC Date Printed: 07/16/14 ADD'L INSURED COPY Page 2 of 3
Pharmacists
Mutual'Insurante
Com Company
NAMED INSURED KYTO INC
POLICY PERIOD 07/01/14 TO 07/01/15
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CUSTOMER # 0006755901 POLICY # BOP 0089544 08
12 01 A.M. Local Time at the described location
SPECIAL PROPERTY COVERAGE SCHEDULE
DESCRIBED PREMISES: HME
Loc. Bldg. PROTECTIVE DEVICE
001 001 MOBILITY AND MORE
493 N DENVER AVE Sprinkler
LOVELAND CO 80537
County:
LARIMER
PROPERTY COVERAGE
COVERAGE B BUSINESS PERSONAL PROPERTY
Replacement Cost
COVERAGE C LOSS OF INCOME NOT TO EXCEED
12 CONSECUTIVE MONTHS
If Glass Coverage applies to your policy, the Glass deductible is
ADDITIONAL COVERAGE
EQUIPMENT BREAKDOWN ENDORSEMENT
PROPERTY PLUS COVERAGES
LIMIT OF INSURANCE
90,000
Actual Loss Sustained
$500.
See Form PM1103B
See Form PM1135B
DEDUCTIBLE
500
500
BOPDEC Date Printed: 07/16/14 ADD'L INSURED COPY
Page 3 of 3