HomeMy WebLinkAboutKYTO INC - INSURANCE CERTIFICATE (5)4tlq pharmacists Pharmacists Mutual Insurance Company
�► Ad mutual 800.247.5930 or 515.295.2461
TOMORROW. IMAGINE THAT. P.O. Box 370, 808 Highway 18 West, Algona, Iowa 5051 1-0370
ITEM ONE
BUSINESS AUTO DECLARATIONS
THIS IS NOT A BILL
NAMED INSURED AND MAILING ADDRESS CUSTOMER NUMBER 00067SS901
KYTO INC POLICY NUMBER CAU 0089544 12
MOBILITY AND MORE Previous Policy Number CAU 0089544
493 DENVER AVE
LOVELAND CO 80537-5129 POLICY PERIOD 07/01/19 TO 07/01/20
12 01 A.M. Local Time at the described location
TRANSACTION -
RENEWAL DECLARATION
INSURED IS: Corporation (C) BUSINESS OF INSURED: Home Medical Equipment
In return for payment of the premium, and subject to all terms of this policy, we agree with you to provide the
insurance as stated in this policy.
ITEM TWO -- SCHEDULE OF COVERAGES AND COVERED AUTOS
Each of these coverages apply only to those autos shown as covered autos by the entry of one or more of the
symbols from the Covered Autos section of the Business Auto Coverage Form next to the name of the coverage.
COVERED
COVERAGES
AUTO
SYMBOLS
LIMIT OF INSURANCE
PREMIUM
Hired Auto
$130.00
Non -Owned Auto
$151.00
Medical Payments
7
5,000
$215. 00
Single Limit Liability
7
8 9
1, 000,000
$4, 904.00
Collision
7
See Schedule
$885.00
Comprehensive
7
See Schedule
$314.00
Garagel(eepers Coverage
See Schedule
$159.00
Uninsured Motorists
7
1, 000,000
$390.00
POLICY PREMIUM TOTAL
$7 , 184 . 00
FORMS AND ENDORSEMENTS
ILU063 (01/09)
ACORD25
(03/16) Certificate of
Liability Ins
CA2048 (10/13)Designated
Insured
PM1000
(01/19) Mutual Company
Provisions
CA0001 (10/13)
Business Auto Coverage
Form
CA0106
(03/94) Collision Covg
in Mexico
CA0113 (10/13)
Colorado Changes
CA0440
(10/13) CO Auto Medical
Payments Covg
CA2150 (07/17)
CO Uninsured Motorists
Coverag
CA2325
(10/13) Cov For Injury
To Lease Worker
CA2345 (11116)
Public or Livery Passenger Con
CA2384
(10/13) Exclusion of Terrorism
CA9937 (10/13)
Garagekeepers Coverage
IL0017
(11/98) Common Policy Conditions
IL0021 (09/08)
Broad Form Nuclear Energy Excl
IL0169
(09/07) CO Chg-Concealment,Misrep,Frau
IL0228 (09/07)
CO Changes -Cancel & Nonrenew
NOTICE: Physical Damage for Hired Autos may be provided. If Comprehensive and/or Collision Coverage show Covered Auto Symbol "8"
Hired Auto Physical Damage is provided. Refer to your policy details.
Authorized Representative GAIL T. WOLFE, CISR, API 4040
CAUDEC 1218 Date Printed: 05/09/19 ADD'L INSURED COPY Page 1 of 3
,HIV pharmacists'"
► / mutual
TOMORROW. IMAGINE THAT.
NAMED INSURED KYTO INC
POLICY PERIOD 07/01 /19 TO 07/01 /20
CUSTOMER # 0006755901 POLICY # CAU 0089544 12
12 01 A.M. Local Time at the described location
ITEM THREE: SCHEDULE OF COVERED AUTOS YOU OWN
Only those coverages listing limits, deductibles or premium are provided. Not all coverages available in all states.
't
w TOTAL
~
Q ¢ RATE Stated PER CAR
Z)
Year Make & Model u~i IW— CLASS Vehicle ID No. (VIN) Value LOCATION PREMIUM
1
2003 FORD WINDSTAR LX WAG4X24D CO 110 024 2FMZA51463BA90515 LOVELAND $1677.00
2
2008 CHRYSLER TOWN & CTRY TOUR CO 110 024 2A8HR54P68R671518 LOVELAND $1412.00
3
2004 TYTA SIENNA XLE AWD/XLE L CO 110 024 5TDBA22C94S017990 LOVELAND $1355.00
4
2004 HOND ODYSSEY EX WAG4X24D CO 110 024 5FNRL18654BO19891 LOVELAND $1298.00
5
2007 CHRYSLER CO 110 024 2A4GP54L97R191908 LOVELAND $1442.00
COVERAGES - PREMIUMS, LIMITS AND DEDUCTIBLES
'*
LIABILITY
UNINSURED MOTORIST
H
z
LIMIT
Premium
LIMIT
Premium
LIMIT
Premium
LIMIT
Deductible
Premium
1
1,000,000
907
1,000,000
390
2
1,000,000
1023
INCLUDED
INCL
3
1,000,000
986
INCLUDED
INCL
4
1,000,000
957
INCLUDED
INCL
5
1,000,000
1031
INCLUDED
INCL
MEDICAL PAYMENTS
COMPREHENSIVE
COLLISION
RENTAL REIMBURSEMENT
H
Rei entCoovered
Z)
LIMIT
Premium
Deductible Premium
Deductible
Premium
Per Day
Premium
1
5,000
43
500
50
5o0
123
2
5,000
43
500
68
500
200
3
5,000
43
500
65
500
183
4
5,000
43
500
58
500
162
5
5,000
43
500
73
500
217
AUDIO VISUAL &
El
TAPES
LOAN/
NON -OWNED AUTO
DATA ELECTRONIC
RECORDS
LEASE
Premium 151
F
ADDED LIMITS
TOWING
& DISCS
GAP
Limit per
Z
D
VALUE
Premium
Disablement
Premium
Premium
Premium
1
2
HIRED AUTO
3
4
$500 Comp. Deductible
5
$500 Collision Deductible
Premium 130
CAU DEC 1218 Date Printed: 05/09/19 ADDT INSURED COPY Page 2 of 3