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HomeMy WebLinkAbout113278 KONE INC - INSURANCE CERTIFICATE (2)The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) INSURER NAIC# COVERAGE POLICY NO. EFF - EXP DATE LIMITS Travelers Casualty & Surety Company 31194 Employment Practices Liability 105676938 09/01/2014 - 09/01/2015 $10,000,000 Aggregate Zurich American Insurance Company 16535 Installation/Erection/All- Risk/Builder Risk IM 4554087-11 12/31/2014 - 12/31/2015 Zurich American Insurance Company Marine Cargo OC5844446 03 01/01/2015 - 12/31/2016 Lexington Insurance Company 19437 Pollution Liability CPO 14157024 09/01/2012 - 09/01/2015 $2,000,000 Each Loss - $5,000,000 Aggregate IF P & C Insurance Company Ltd. Professional Liability LP 0000002172 01/01/2015 - 12/31/2015 $10,000,000 Each Loss - $10,000,000 Aggregate American Guarantee & Liability Insurance Co. 26247 Property Including Stored Materials MCP4257344-11 01/01/2015- 01/01/2016 Old Republic Insurance Company 24147 Stop Gap MWC11539707 01/01/2015 - 01/01/2016 EL Each Accident $2,000,000 / Disease-Policy Limit $2,000,000 / Disease-Each Employee $2,000,000 Old Republic Insurance Company 24147 Workers Compensation and Employers' Liability MWC11539707 (AOS) 01/01/2015 - 01/01/2016 WC Statutory Limit/EL Ea Acc $2,000,000/EL Disease Ea Emp $2,000,000/EL Disease Pol Limit $2,000,000 SCHEDULE OF OTHER POLICIES 12/12/2014 KONE Inc. Attn: insurancerequests@kone.com One KONE Court Moline IL 61265 City of Fort Collins PO Box 580 Fort Collins CO 80522-0580 DATE ISSUED NAMED INSURED: CERTIFICATE HOLDER: ecertsonline™ SCHEDULE OF OTHER POLICIES CERT NO.: 22629894 CLIENT CODE: 000-U.S. Cheryl Gabriel 12/12/2014 9:29:52 AM (CST) Page 2 of 5 This certificate cancels and supersedes ALL previously issued certificates. THIS FORM APPLIES IN STATES WHICH USE: CA 00 01 (10-13) IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person(s) or Organization(s): All persons or organizations as required by written contract. With respect to COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured is changed with the addition of the following: Each person or organization shown in the Schedule for whom you are doing work is an "insured". But only for "bodily injury" or "property damage" that results from the ownership, maintenance or use of a covered "auto" by: 1. You; 2. an "employee" of yours; or 3. anyone who drives a covered "auto" with your permission or with the permission of one of your "employees". However, the insurance afforded to the person or organization shown in the Schedule shall not exceed the scope of coverage and/or limits of this policy. Not withstanding the foregoing sentence, in no event shall the insurance provided by this policy exceed the scope of coverage and/or limits required by the contract or agreement. PCA 001 10 13 MWTB 20018 KONE Holdings, Inc. 01101/2015- 01/01/2016 12/12/2014 KONE Inc. Attn: insurancerequests@kone.com MWZY 57732 City of Fort Collins PO Box 580 Fort Collins CO 80522-0580 CERT NO.: 22629894 CLIENT CODE: 000-U.S. Cheryl Gabriel 12/12/2014 9:29:52 AM (CST) Page 3 of 5 This certificate cancels and supersedes ALL previously issued certificates. 12/12/2014 KONE Inc. Attn: insurancerequests@kone.com MWZY 57732 City of Fort Collins PO Box 580 Fort Collins CO 80522-0580 CERT NO.: 22629894 CLIENT CODE: 000-U.S. Cheryl Gabriel 12/12/2014 9:29:52 AM (CST) Page 4 of 5 This certificate cancels and supersedes ALL previously issued certificates. CERT NO.: 22629894 CLIENT CODE: 000-U.S. Cheryl Gabriel 12/12/2014 9:29:52 AM (CST) Page 5 of 5 This certificate cancels and supersedes ALL previously issued certificates. PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12/12/2014 Aon Risk Services Central, Inc. Chicago IL Office 200 East Randolph Chicago, IL 60601 866-283-7122 847-953-5390 Aon Risk Services Central, Inc. Aon Client Services KONE Inc. Attn: insurancerequests@kone.com One KONE Court Moline IL 61265 22629894 ✓ ✓ Certificate Holder and other parties as required by contract are listed as additional insured to the extent of the terms of the contract. City of Fort Collins PO Box 580 Fort Collins CO 80522-0580 Contract No. 40127571 - Project/Location: Various locations 40127571 Fort Collins, CO Completed Operations shall be maintained per the terms of the contract. 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 2,000,000 A ✓ MWZY 57732 1/1/2015 1/1/2016 ✓ ✓ A MWTB 20018 1/1/2015 1/1/2016 ✓ A MWC 11539707 (AOS) 1/1/2015 1/1/2016 ✓ A MWXS 82207 (OH) 1/1/2015 1/1/2016 N Other Policies See Schedule of Other Policies Old Republic Insurance Company 24147 CERT NO.: 22629894 CLIENT CODE: 000-U.S. Cheryl Gabriel 12/12/2014 9:29:52 AM (CST) Page 1 of 5 This certificate cancels and supersedes ALL previously issued certificates.