HomeMy WebLinkAbout521604 KECI COLORADO INC - INSURANCE CERTIFICATE (2)ACORDrM CERTIFICATE OF LIABILITY INSURANCE vuzol5
DATE
9/25//25/2014
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 Lockton Companies
8110 E Union Avenue
Suite 700
Denver CO 80237
(303) 414-6000
A No Ea : A/C No):
EMAIL
INSURERISI AFFORDING c
Ic If
INSURER A: The Charter Oak Fire Insurance Company
25615
INSURED K.E.C.I, Colorado, Inc.
1050899 5750 W. Airport Rd.
Sedalia, CO 80135
INSURER B: Travelers Prop. Casualty Co. of Am.
INSURER C : Pinnacol Assurance
INSURER F;
. !'A]OV11 RFVLCInM MIIMRFR• XXXXXXX
COVERAGES 1lLl.l.V¢r. ..,V..I V n.,muu�. •c���.. - - -
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.
INTR
TYPE OF INSURANCE
ADDLSUBIR
D
POLICY NUMBER
POQCV EFF
1/l/2014
POLICY EXP
I/1/2015
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
iohs to
Y
N
DTC06C647481
EACH
OCCURRENCE
1000000
PR
MI ET EaErterra
300OOO
MED EXP (My one rson
5,000
PERSONAL SADVINJURY
$ 1000000
Pollution
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY PELT LOC
OTHER
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
g
AUTOMOBILELwelutY
X ANYAUTO
ALTOS NED
HIRED AUTOS SCHEDULEDUTO
NON -OWNED
X X AUTOS
y
N
DT810325D9148
1/12014
I/12015
E...deDSINGLE LIMIT
$ 1000000
BODILY INJURY (Per pelson)
$ XXXXXXX
BODILY INJURY (Per accident
s XXXXXXX
PROPERTY DAMAGE
Per aceden
$XXXXXXX
$XXXXXXX
B
X
UMBRELLALUIB
EXCESS LUMB
X
OCCUR
CLAIMS -MADE
N
N
DTSMCUP325D9148
1/12014
I/l2015
EACH OCCURRENCE
$ 5000000
AGGREGATE
$ 5,000,00
DED X RETENTION 410,000
s XXXXXXX
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
AWPROWMfMBERE%RTNE ECUTIV N❑
OFFICEIMa.Wel In NN)
DESCRIPDON OF OPERATIONS We
NIA
N
4048534
10/1/2014
10/12015
X STATUTE OTH
E.L. EACH ACCIDENT
$ 500000
E.L. DISEASE - EA EMPLOYEE
500000
E.L. DISEASE - POLICY LIMIT
500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule. may be attached If more space Is required)
RE: 7519 Lemay Ave Bridge Expansion Joint. The City, its officers, agents and employees are additional insured as respects General and Auto Liability if
required by written contract per policy terms and conditions. Ten(10) Day Notice of Cancellation will be provided to the City for non-payment.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
12439811
City of Fort Collins
Purchasingg Department
PO Box 280
Ft Collins CO 80522
......,.. rya,..,.,. 014AR14a1d ACORO CORPORATION- All Hants reserved
Th. ACnan ...... e...l I..,...... .aal.f...A mark. of Ar:nRn