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HomeMy WebLinkAboutI-KOTA INC - INSURANCE CERTIFICATE (3)IKOTA-1 OP ID: LIZ ,�coRO CERTIFICATE OF LIABILITY INSURANCE DATE 03/03/201 YY) 03/03/2016 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 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 Cherry Creek Ins. Agency, Inc. Suite 500 CONTNAMEACT Ginny Shaw PHONE FAX A/C NU EXt : 303-799-0110 A/C No): 303-799-0156 5660 Greenwood Plaza Blvd. EJMAILss: GinnyS thinkcci .com Greenwood Village, CO 80111 Steven L. Doss INSURERS AFFORDING COVERAGE NAIC # INSURER A: Westfield Insurance 24112 INSURED I -Kota Inc INSURER B : Plnnacol Assurance 41190 4640 Pecos Street, Unit F Denver, CO 80211 INSURER C : Hanover Insurance INSURER D : INSURER E : 114SUPER F : COVERAGES CERTIFICATE NUMBER: 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 ADDL POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE lxl OCCUR X CMM0982161 03/10/2016 03/10/2017 DAMAGE TO RENTED — PREMISES Ea occurrence $ 500,00 MED EXP (Any one person) $ 5,00 _ PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 POLICY PRO- LJ LOC F-] PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 A X ANY AUTO CMM0982161 03/10/2016 03/10/2017 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE CMM0982161 03/10/2016 03/10/2017 DED I X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y�I OFFICER/MEMBER EXCLUDED? L I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A I 4138898 '4 13" 04/01/2015 04/01/2016 04/01/2016 04/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 ' E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 C Leased/Rented IH4959369303 06/25/2015 06/25/2016 Limit 250,00 Equipment - ACV RC BY WRITTEN CONTRACT Ded 1,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As required by written contract or written agreement, City of Fort Collins is included as Additional Insured under General Liability. %,Cr[ I Ir16.H I C rIVLLJr_M UANL;tLLA I IUN City of Fort Collins 300 LaPorte Avenue Fort Collins, CO 80521 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD