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HomeMy WebLinkAboutKLM CONSTRUCTION INC - INSURANCE CERTIFICATE (2)ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MIN DD YYYY) 09/17/2019 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(les) 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 NAME: Cheryl Johnson AX PHONE (AICEtI,720 370-2833 NCC, NI. 720.370-2866 Advantage 1 Insurance 90 W. 84th Ave. E-MAIL h te I advanta e ADDRESS; ry g onsins.com INSURE E AFFORDING COVERAGE NAIC# Denver, CO 80260 INSURER A: Midwest Family INSURED INSURER B: Travelers INSURERC: KLM Construction Inc. INSURER D: 7000 W 14th Ave INSURER E: Lakewood, CO 80214 INSURER F : COVERAGES CERTIFICATE NUMBER: 00000000-1269915 REVISION NUMBER- 94 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 JJLMa TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A XCOMMERCIAL GENERAL LIABILITY CLAIMS -MADE NIOCCUR CPCO0560116085 09/15/2019 09/15/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 50.000 MED EXP one n E Excluded PERSONAL 8 ADV INJURY $ 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a TEECT 7 LOC OTHER: GENERAL AGGREGATE $ 2.000.000 PRODUCTS-COMPIOP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY X I AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY CPCO0560116085 09115/2019 09/15/2020 (Ea accident)COMBINED SINGLE LIMIT $ 1.000.000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per aaident) $ $ A X uMBRELLALIAB OCCUR EXCESS LIAB -( CLAIMS -MADE 1 CPCO0560116085 1 09/15@019 09/15/2020 EACH OCCURRENCE E 6,000,000 AGGREGATE $ 8,000,000 DIED I X I RETENTION $ 10000 $ A WORKERSCOMPENSAT10N AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS belay NIA CPCO0560122177 05/13/2019 05/13/2020 X I PER OTH- E.L EACH ACCIDENT S 1,000,000 E.L DISEASE - EA EMPLOYEE S 1,000,000 E.L. DISEASE -POLICY LIMIT S 1,000,000 B Employee Theft bond 106825317 10/30/2018 10/30/2019 $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N mom space is required) City of Fort Collins PO Box 580 FORT COLLINS, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by CLJ on September 17, 2019 at 09:51AM