HomeMy WebLinkAboutK.E.C.I. COLORADO INC - INSURANCE CERTIFICATE (2)ACORD, CERTIFICATE OF LIABILITY INSURANCE
F DATE(MM/DD/VYYY)
In/2020
1 9/17/2019
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(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 Lockton Companies
8110 E Union Avenue
Suite 700
Denver CO 80237
CONTCT
O&RREA
A/c Ext : FAX
No
E-MAILU_
ADDRESS:
INSURERISI AFFORDING
(303) 414-6000
INSURER A: The Charter Oak Fire Insurance Company
25615
INSURED K.E.C.LColorado, Inc.
1050899 5750 W. Airport Rd.
Sedalia, CO 80135
INSURER B: 1'heIravelerslndernnityCompmyofConnecticut
25682
INSURER C : Pinnacol Assurance
I D ; travelers Progeny Casualty Co ofAmerira
25674
RER E
INSURER F :
rnVFReaFR KFCC0 01 CFRTIFICATF NIIM1RF1i I?AIQRl l RFVIQIr1W MIIaaRFR• YYYYYYY
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
AN DDL
SUBR
WVD
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FRIOCCUR
Limited Jobsite
Y
N
D'I'C06C647481C0F19
1/1/2019
l/l/2020
EACH OCCURRENCE
1,000,000
DAMIAGE TO RENTEDSZS (Es
300OOO
X
MED EXP (Any oneperson)
5,000
Pollution
PERSONAL $ADV INJURY
$ 1 OOO OOO
GEN'L AGGREGATE LIMIT APPLIES PER.
POLICY JECT LOC
OTHER.
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
B
AUTOMOBILE LIABILITY
ANYAUTO
AUTOS ONLY SCHEDULED
AU OS ONLY X AUUTOS ONLY
Ix
Y
N
DT8103LO6983ITCT19
1/1/2019
1/1/2020
COMBINEDBIIdISINGLE LIMITEa
$ 1 000 000
BODILY INJURY (Per person)
$ XXXXXXX
BODILY INJURY (Per accident
$ XXXXXXX
PROPERTYtDAMAGE
$ XXXXXXX
$ XXXXXXX
D
X
I UMBRELLALIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
N
N
CUPOJ4047221926G
1/1/2019
l/l/2020
EACH OCCURRENCE
s 5 000.000
AGGREGATE
$ 5,000,000
DIED I X I RETENTION $ 10,000
$ XXXXXXX
C
ANDEMPLOYERS•LIABIRKERS ON Y/N
ANY PROPMETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
IMaadilory In NMI
It yes, descno, under
DESCRIPTION OF OPERATIONS WM
NIA
N
4048534
10/1/2019
10/l/2020
OTH-
X STATUTE rR
EL EACH ACCIDENT
is 500000
E.L DISEASE - EA EMPLOYEE
Is 500,000
E.L DISEASE - POLICY LIMIT
is 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more specs is required)
RE: 7519 Lemay Ave Bridge Expansion Joint. The City, its officers, agents and employees are additional insured as respects General and Auto Liability if
required by written contract per policy terns and conditions. Ten(10) Day Notice of Cancellation will be provided to the City for non-payment.
GtKI IHIOAI It HULUtK CANOhLLAI IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
12439811
AUTHORIZED REPRESENTATIVE
City of Fort Collins
Purchasingg Department
PO Box 280
Ft Collins CO 80522
ACORD 25 (2016/03) 1988-210115 ACORD CORM RATION. All rights reserved
The ACORO name and logo are registered marks of ACORD