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HomeMy WebLinkAbout111775 KUBAT EQUIPMENT & SERVICE CO - INSURANCE CERTIFICATE (2)GATE (MM/DDNYYY) A� " CERTIFICATE OF LIABILITY INSURANCE 11/30/2015 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 CONTACT Mike Sj erven NAME: _ Moody Insurance Agency, Inc. aoN c . (303) 824-6600 F� No: (303)370-0118 8055 East Tufts Avenue E-MAIL-ADDRESS: -MAILADDRESS: � y mike s erven@nmood ins.com Suite 1000 INSURERS AFFORDING COVERAGE NAIC # Denver CO 80237 INSURER A:Home land Ins co of NY 134452 INSURED INSURERB:Cincinnati Indemnity Company 23280 Kubat Equipment & Service Company, Inc.(KESCO) INSURERC:Pinnacol Assurance 41190 KESCO Enterprises, LLC INSURERD: 1070 S Galapago St INSURERE:_ Denver CO 80223 INSURERF: rnvGoer_cc CFRTIFICATF N1111ARFR•15-16 No Forms No UMB RFVISInN NIIMRFR: 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 A L UBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE �X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ 100,000 MED EXP (Any one person $ 5,000 7930040310000 12/1/2015 12/1/2016 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 PRO - POLICY ❑X PRO JECT ❑ LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS EBA0219301 12/1/2015 12/1/2016 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per acc dent $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE X OTH- STATUT R E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 C OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A 4119184 12/1/2015 12/1/2016 E.L. DISEASE -POLICY LIMIT $ 1 000 000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins 330 South College Avenue P.O. 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 ike Sjerven/MIKSJE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD I NS025 (201401)