HomeMy WebLinkAbout111775 KUBAT EQUIPMENT - INSURANCE CERTIFICATE`'� �® CERTIFICATE OF LIABILITY INSURANCE
i2/1/2014
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
Moody Insurance Agency, Inc.
._.
BOSS East_ Tufts__ Avenue
Suite 1000
Denver CO 80237
CONTACT NAME: Charlene Navarra, ACSR,- CRIS
NA
PHONE (3031824-6600 PAX Ne:.(303)3Y0L0110
E-MAIL
ADDRESS. cnavarra@moodyins.com
INSURERS AFFORDING COVERAGE
NAICS
INSURERA:Everest Indemnity Insurance Co
INSURED
Rubat Equipment & Service Company, Inc. (XESCO)
RESCO Enterprises, LLC
1070 S Galapago St
Denver CO 80223
INSURER B:Cincinnati Indemnity Company23280
INSURERC:Pinnacol Assurance
1190
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 14-15 No Forms/No Umb 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
A L
POLICY NUMBER
POLICY EFF
MWDDNYYYI
POLICY EXP
(MMMDNYWI
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADEOCCUR
BF4ML00081141
12/1/2014
12/1/2015
EACH OCCURRENCE
$ 11000,000
DAMAGE TO PREMISES EaoccurrDence
$ 100,000
MED EXP (Any one person)
$ 51 000
PERSONAL &ADV INJURY
S 1, 00"000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE
X POUCYF_J
LIMIT APPLIES PER:
PRO LOD
PRODUCTS-COMP/OP AGG
S 2,000,000
3
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALLOWNED SCHEDULED
AUTOS AUTOS
HIRED AUTOS .NON -OWNED
AUTOS
EBA0219301
2/1/2014
-
12/1/2015
COMBINED SINGLE LIMIT .
Ea accident
1'000 000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
.S
Uninsured motorist Bl-sin le
S 11000,000
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
S
DIED I I RETENTIONS
$
C
WORKERS COMPENSATION
ANDEMPLOYERS'LIABILITY YIN
ANY PROPRIETONPARTNER,EXECUrIVE
OFRCENMEMBER EXCLUDED'! �
(Mandatory in NH)
11 yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
4119184
2/1/2014
2/1/2015
X WC STATU- OTH-
E.L. EACH ACCIDENT
$ 11000,000
E.L. DISEASE - EA EMPLOYE
3 1 000,000
EL.DISEASE - POLICY LIMIT
3 1 000 000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 8 more space is rarluired)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
330 South College Avenue P.O. Box 580 AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522-0580
25 (2010/05)
Navarra, ACSR, CRIS ckCt�
O 1988-2010 ACORD CORPORATION. All rights reserved_
INS025 wri oosl.ol The ACORD name and logo are registered marks of ACORD