HomeMy WebLinkAbout493755 KDG ENGINEERING LLC - INSURANCE CERTIFICATE (7)DA'FE(MM,DD/YYYYj
1...► CERTIFICATE OF LIABILITY INSURANCE 1zra�r2o�s
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TI/IS CERT1fRCATE IS ISSL DASAMATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THECERTIFICATEHOLDER. THIS CERTIFICATE DOES NOTAFFIRMAnVEtr ORNEGATIVELY
AMEND, EXTEND OR ALTER THE.COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTiFICATr OI: INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(,S),
AUTHORIZED REPRESEIITNTIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT Ifthe cerdBccalle holder H anADOMONA1 INSURED, the PONW166) mutt haveADDTIONAL INSURED provisions or be endorsed, If SUBROGATION IS WAIVED, subject to the terms sand
conditions of #ha poft certain poNoks may require an endorsement. A sUtemerx on this C/Rfi eo dM no ConW rights to the Cert?(rtate holder In lieu of such eridOr4ement(S).
PRODUCER CONTACT
Tim Stuber(071738G) NAMEPHONE FAX
12996 Sheridan Blvd Ste 102 (A NO, EXT): 303.410.I OW 1 (A/c. NO).' 303-416.4444
E-MAIL
8l MfWd CO 8W20•1488 ADDRESS: tstuberigfarmersageryt_com
INSUIi£R(S)AfPORC'RNGCOYERAEsE NAICa
INSURED INISURERA, Truck fnSUranOe Exchange 21709
INSURER& Farmers In3uranoe, Exchange 21t"s52
KDG ENGINEERING LLC -- - - — — -
INStYRER a Mid Century lnsLT!nce Cornpany 2168'7
7220 W JEFFERSON AVE # 406 - --
1 INSURER D:
LLMEW iDd3D CO W235 INSURERE
INSURER F:
COVERAGES CERTIFICATE NIM UR: REVISION NUMBER.
rHIS 6 TO CCFMFY 7HAT THE POLICIES OF INSURANCE U$TED BELOW HAVE BEEN allED TO THE 04SURED NAAAE ADM FoR THE POLICY PERIOD WDICATED.NDRWYaTHSTAatDINGANY
REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHOCH THIS CERTIFICATE MAY RE ISSUED OR MAY PERTAiN THE INSURANCE AFFORWD BYTHE
i POULIESDESCRIBED HEREN1SSUBIECTTOAUTHE TERMS. EXCILLMIONSANOCONMT161ArVSlrwDrursrc iiuirecxanwuuevuwvener..ae�..,rc'.nv
INSR
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TYPE OF INSURANCE
ADOTL
IHSD
I SUER
WVD
POLICY NUMBER
_
POLICYEFF POU.YE%P - -I
I (MMYOOIYYYY) (PAM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIAIMUTY
_—_
EACH OCCURRENCE 4 2.000
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CUUAAS-WADE I. " 1 OCCUR
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PREMISIS(EaOccurrence) 250,006
M_DExP(Anyormperson) S -SO110
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06722232
12115re018 12115.2019 PERSONAL&ADVINJURY $ 2,00000�0
GCN L AGGREGATE UMITAPPUES FEWvENERALAGGKGATE
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POLICY PROJe'C7 tOC
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4.000.000
PRODUCTS' ODMPV`OPAGG ,i�- 2.000.0
OTHER:
AUTOMOBILE UABIUTY
LOAIBIN60 VNGLE LIMIT
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(Ea xfident) 2,000,000
ANwa1910
BODILY INjl1RY(Psrperson) S "
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1
OWNEDAUTOS SCHEDULED
ONLY AUTOS
4015722232 �
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UMBRELLALIAB
OCCUR
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$ 4.000.
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EXCESS LIAR
CLAIMS -MADE
a1306722556
12/15/2018
1211 &2019
AGGREGATE
S 4 p00 p
DED I RETENT)ON S
WORK UCOMPENSATION
AND EMPLOYERS'UABILITY
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ANY PROPRIETOR/PARTNER/ YIN
EXECUTIVE OFFICER/Urma-R NIA
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17115/2019 IF L. EACH. ACCIDENT S 1.000.0
EXCLLIDED?(Mandatory in NH)
E.L. DISEASE -CA EMPLOYEE 1,000,OCIa
Iryea, descntae iindee DESCRIPTION OF
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E.LDtSEASE-PO"YLIM+T '# 11000,000
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DESCRIPTION OF OPEPAT10NSILOCATIONSIVEHICLES (ACORD 101, Addhiorut Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER ALSO LISTED AS ADDITIONAL INSURED (PLEASE SEE ATTACHED REMARKS)
CERTIFICATEi4OLDER _ CANCELLATION .,.
S
HOULD ANY OFTHE ABOVE DESCRIBED POUCIE"JIIZ NCELL.ED BEFORE THE EXPIRATION
PURCFLASING DEFT E THEREOF, NOTICE W ILL BE DEUVUEVLWApdbRDANCE WITH THE POLICY PROV1S1011
PO BOX 560 - __-
ACORD 25 (2016f 03) 01988-201 S ACORD CORPORATION. All Rights Reserved
31.1769 11-15 The ACORD name and logo are registered marks of ACORD
AGENCY
TIM STUBER INSURANCE AGENCY LLC
POLICY KOBER
6%72223ZW6722566.AN 175657
CAIMSER
FARMERSINSURANCE
AGENCY CUSTOMER ID: KDG ENGINEERING LLC
LOC #: 1
ADDITIONAL REMARKS SCHEDULE
NAMED INSU:lEO
KDG ENGINEERING LLC
7220 W JEFFERSON AVE W6
LAKEWOOD CO 80235
NAN:CODE
21687 1 E►FECTWE DATE, 12/15/2018
Page of
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM1,
FORM NUMBER: 6CORD25 FORM TITLE: 4Q1
THE GENERAL LIABILITY, AUTOMOBILE LIABILITY, UMBRELLA LIABILITY APPLIES ON A PRIMARY NON CONTRIBUTORY BASIS. A WAIVER OF
SUBROGATION APPLIES FOR GENERAL LIABILITY,AUTOMOSILE LIABILITY, UMBRELLA LIABILITY AND WORKERS COMPENSATION.
RE -DRAKE BRIDGE REPLACEMENT PROJECT
n4vnu zu, tcuumui 1 (9 2008 ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACQRD