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Home My WebLink About103118 KWAL-HOWELLS INC - INSURANCE CERTIFICATE (4)AC6)? b® CERTIFICATE OF LIABILITY INSURANCE 43TO/2o 4 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). GPanl yyGroup, Inc. - Cleveland 6000 Freedom Square Drive CONTC NAMEp T Sally Harper PHONEExIl 216-447-1050 FnAc Ne:216-447-4088 al oalLss: Sally.Har er H lant.com Suite 400 Cleveland, OH 44131 INSURER(S)AFFORDING COVERAGE NAIC! INSURER A :National Union Fire Insurance Co. of Pittsburgh, PA 19445 Inc. , NW 7dand INSURER B INSURERC:Qualified Self Insurance INSURERD:Safet National CasualtyCorp. 15105 4115 C T-1 INSURER E: INSURER F COVERAGESCERTIFICATE 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MWDDIYYYV POLICY EXP MMJDD/YYV LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR GL5094663 GL5094664 05/01/14 05/01/14 05/01/16 05/01/16 EACH OCCURRENCE S 1,000,000 PREMISES ItsEa¢unence $ 1,000,000 MED EXP(Any one perm) S PERSONAL &ADV INJURY § 1,000,000 GENERAL AGGREGATE $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMPIOP AGG § 1,000,000 EA OCC PROD-0OMP/OP § 1,000,000 A A A AUTOMOBILE LIABILITY ANY AUTO AUTOS NED AUTOSULED HIRED AUTOS X AUTOSNON-OWNED CA5196415(AOS) CA5196416 (MA) CA5196417(VA) 05/01/14 05/01/14 05/01/14 05/01/16 05/01/16 05/1 EOa aB EEDt SINGLE LIMIT § 1,000000 X BODILY INJURY (Per peson) $ X BODILY INJURY(Pet accident) $ X (PReracReen DAMAGE S S UMBRELLA LIAB EXCESS LIAB DDCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE § DED RETENTION $ EA OCC PROD/COMP OP § D D C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY OFFICER/MEMBER EXCLUDE/D?ECUTIVE � (Mandatory in NH) If SCRIes I ON OF OPERATIONS aebw NIA LDS4041894 PS4041895 SELF INSURED SEE DESC. ( ) 05/01/14 05/01/14 05/01/15 05/01/15 X WC STATU- I OTH E.L. EACH ACCIDENT S 1,000,ODO E.L. DISEASE - EA EMPLOYE § 1,000,000 E.L. DISEASE -POLICY LIMIT § 1,000,000 D EXCESS WORKERS' COMP EMPLOYERS LIAB SP4048477 (AOS) SP4050773(FL) 5/01/14 5/01/14 5/01/15 5/01/15 WC STATUTORY AND 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 ® 1988-2010 ACORD CORPORATION. All rights reserved. AL,IJKU Zb (ZUIV/Ub) I he ACORD name and logo are registered marks of ACORD INSURED Kwal-Howells, Inc. CERTIFICATE HOLDER: DATE 4/30/2014