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Home My WebLink About111775 KUBAT EQUIPMENT & SERVICE CO - INSURANCE CERTIFICATEAte-.^ �® lv(J//� CERTIFICATE OF LIABILITY INSURANCE DATE (/21120 YYYY) ,,,Z„20,8 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 have ADDITIONAL INSURED provisions or 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 CONTACT Brandie Zuckerman, CIC NAME: Moody Insurance Agency, Inc. PH I, r o Ext : (303) 824-6600 A/c, No): (303) 370-0118 8055 East Tufts Avenue E-MAIL brandie.zuckerman@moodyins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Suite 1000 Denver CO 80237 INSURER A : Homeland Ins Co of NY 34452 INSURED INSURER B : Cincinnati Indemnity Company 23280 INSURER C : Pinnacol Assurance 41190 Kubat Equipment & Service Company, Inc (KESCO) INSURER D : KESCO Enterprises, LLC INSURER E : 1070 S Galapago St INSURER F : Denver CO 80223-2804 COVERAGES CERTIFICATE NUMBER: 18-19 Master 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 AIJUIL INSD 51JUH WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 7 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 150,000 IVIED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A 7930040310003 12/01/2018 12/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS EPP0219301 12/01/2018 12/01/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LAB CLAIMS -MADE 7930040320003 12/01/2018 12/01/2019 AGGREGATE $ 5,000,000 DED I X1 RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE 7NNIA OFFICER/MEMBER EXCLUDED (Mandatory in NH) 4119184 12/01/2018 12/01/2019 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 Pollution 1,000,000 P Professional Pollution 7930040310003 12/01/2018 12/01/2019 Professional 1,000,000 Policy Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GLK I IFIGA I L HULULK 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 AUTHORIZED REPRESENTATIVE P.O. Box 580 Fort Collins CO 80522-0580 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 3656 LOC #: A�R" ADDITIONAL REMARKS SCHEDULE Page of AGENCY Moody Insurance Agency, Inc. NAMED INSURED Kubat Equipment & Service Company, Inc.(KESCO) POLICY NUMBER CARRIER Homeland Insurance, Cincinnati Insurance, Pinnacol Assurance NAIC CODE EFFECTIVE DATE: 12/01/2018 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: Notes CONTRACTUAL LIABILITY APPLIES PER POLICYTERMSAND CONDITIONS General Liability: OBENV GE 301 0211 Form Attached Includes: Blanket Additional Insured for ongoing operations status applies only to the extent provided in form OBENV GE 301 0211 when required by written contract. OBENV GE 304 0211 Form Attached Includes: Blanket Additional Insured for Completed Operations status applies only to the extent provided in form OBENV GE 304 0211 when required by written contract. OBENV GE 320 0411 Form Attached Includes: Blanket Waiver of Subrogation applies only to the extent provided in form OBENV GE 320 0411 when required by written contract. OBENV GE 319 0211 Form Attached Includes: Primary and Non -Contributory status only to the extent provided in form OBENV GE 319 0211 when required by written contract. OBENV GL 324 0713 Form Attached Includes: Designated Project General Aggregate applies only to the extent provided in form OBENV GL 324 0713 when required by written contract. Auto Liability: AA4171 1105 Form Attached Includes: Blanket Additional Insured status applies only to the extent provided in form AA 4171 1105 when required by written contract. AA 4172 0909 Form Attached Includes: Blanket Waiver of Subrogation applies only to the extent provided in form AA 4172 0909 when required by written contract. Excess Liability: Excess Liability policy is on a follow form basis for the following underlying insurance coverages: General Liability, Pollution Liability, Professional Liability, Automobile Liability, and Employers Liability. Additional insured status will follow when required by written contract. OBENVXS 300 0411 Form Attached Includes: Blanket Waiver of Subrogation applies only to the extent provided in form OBENVXS 300 0411 when required by written contract. OBENVXS 201 0411 Form Attached Includes: Primary and Non -Contributory status only to the extent provided in form OBENVXS 201 0411 when required by written contract. Worker's Compensation: 359-6 From Attached Includes Blanket Waiver of Subrogation. Status applies when required by written contract. Leased / Rented Coverage - 50,000 Cincinnati Insurance Company - Policy Number EPP0219301 Effective 12/01/2018 - 12/01/2019 IMPORTANT: The policy forms referenced will be sent via email only. To obtain copies, please send your request with the email address to certrequest@moodyins.com. ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD