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HomeMy WebLinkAboutTRIAD INC - INSURANCE CERTIFICATEACCJRO® CERTIFICATE OF LIABILITY INSURANCE `� DATE(MM/DD/YYYY) 10/12/2018 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 UUNIACT Kathleen Kramer NAME: Cornerstone Kansas City, LLC PHONE (913) 754-0193 FAX (913)378-0399 A/C No Ext : A/C No): 4400 College Blvd. Ste. 350 E-MAIL kkramer@ckcins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Auto Owners Mutual Insurance Cc 18988 Overland Park KS 66211 INSURED INSURERB:Owners Insurance Company 32700 INSURER C: Missouri Employers Mutual Ins Co. 10191 Triad Inc. INSURER D: Argonaut 19801 2929 SW US Highway 40 INSURER E : INSURER F: Blue Springs MO 64015-7276 COVERAGES CERTIFICATE NUMBER:CL18101226195 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 POLICIFS LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R ILTR TYPE OF INSURANCE ADDL INSD WVDSUBI POLICY NUMBER MMIDDPOLICY/YYYY MM IDDIIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR REMDAMAGE T RENTED PREM PISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 10,000 184605-75135390-18 10/20/2018 10/20/2019 PERSONAL & ADV INJURY $ 1,000,000 L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY �jE LOC M'OTHER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ Per written contract AUTOMOBILE LIABILITY COMBINED Ea accident SINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS 51-463-727-01 10/20/2018 10/20/2019 BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 A EXCESS LIABI I CLAIMS -MADE DED X I RETENTION $ 10,000 $ 51-463-727-02 10/20/2018 10/20/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PRV 2032385-00 (KS) 7/2/2018 6/9/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I N ! (Mandatory in NH) N I'e' bmm 2021302-02 (M) 6/9/2018 6/9/2019 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Workers' Compensation WC-92-839-867022 (AOS) 6/9/2018 6/9/2019 Limits 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 281 N College Ave ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80526 AUTHORIZED REPRESENTATIVE David Parkhurst/KK © 1988-2014 ACORD CORPORATION. All rights reser ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)