HomeMy WebLinkAboutKYTO INC - INSURANCE CERTIFICATE (8)Pharmacists
Mutual'InsurancePharmacists Mutual Insurance Company
800.247.5930 or 515.295.2461
Company P.O. Box 370, 808 Highway 18 West, Algona, Iowa 50511-0370
BUSINESS AUTO DECLARATIONS
ITEM ONE THIS IS NOT A BILL
NAMED INSURED AND MAILING ADDRESS CUSTOMER NUMBER 0006755901
KYTO INC POLICY NUMBER CAU 0089544 11
MOBILITY AND MORE Previous Policy Number CAU 0089544
493 DENVER AVE
LOVELAND CO 80537-5129 POLICY PERIOD 07/01/18 TO 07/01/19
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.
COVERAGES
Hired Auto
Non -Owned Auto
Medical Payments
Collision
Comprehensive
Single Limit Liability
Garagekeepers Coverage
Uninsured Motorists
COVERED
AUTO SYMBOLS LIMIT OF INSURANCE PREMIUM
7
5,000
7 8
See Schedule
7 8
See Schedule
7 8 9
1,000,000
See Schedule
7
1,000,000
POLICY PREMIUM TOTAL
FORMS AND ENDORSEMENTS
ILU063 (01/09)
CA2150 (07/17) CO Uninsured Motorists Coverag
CA0106 (03/94) Collision Covg in Mexico
CA0440 (10/13) CO Auto Medical Payments Covg
CA2345 (11/16) Public or Livery Passenger Con
CA9937 (10/13) Garagekeepers Coverage
IL0021 (09/08) Broad Form Nuclear Energy Excl
IL0228 (09/07) CO Changes -Cancel & Nonrenew
$130.00
$158.00
$155.00
$615.00
$301.00
$3,526.00
$163.00
$370.00
$5,455.00
CA2048
(10/13)Designated
Insured
CA0001
(10/13)
Business Auto Coverage Form
CA0113
(10/13)
Colorado Changes
CA2325
(10/13)
Cov For Injury To Lease Worker
CA2384
(10/13)
Exclusion of Terrorism
IL0017
(11/98)
Common Policy Conditions
IL0169
(09/07)
CO Chg-Concealment,Misrep,Frau
PM1000
(09/12)
Mutual Company Provisions
WARNING: A person who knowingly submits an application or files a claim with intent to defraud or helps commit a fraud against
an insurer may be guilty of a crime and may be subject to criminal and civil penalties.
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 Date Printed:05/14/18 ADD' L INSURED COPY Page 1 of 3
Pharmacists
MUtUaflnsuranceComan y
p �
NAMED INSURED KYTO INC
CUSTOMER NUMBER 0006755901
POLICY NUMBER CAU 0089544 11
POLICY PERIOD 07/01/18 TO 07/01/19
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.
ft
W
TOTAL
Z
w RATE Stated PER CAR
Year Make & Model cn I-- CLASS Vehicle ID No. (VIN) Value LOCATION PREMIUM
1
2003 FORD WINDSTAR LX WAG4X24D CO 110 024 2FMZA51463BA90515 LOVELAND $1710.0
2
2008 CHRYSLER TOWN & CTRY TOUR CO 110 024 2A8HR54P68R671518 LOVELAND $1331.00
3
2004 TYTA SIENNA XLE AWD/XLE L CO 110 024 STDBA22C94S017990 LOVELAND $1270.00
4
2004 HOND ODYSSEY EX WAG4X24D CO 110 024 5FNRL18654BO19891 LOVELAND $1144.00
COVERAGES - PREMIUMS, LIMITS AND DEDUCTIBLES
'e
LIABILITY
UNINSURED MOTORIST
H
z
Z)
LIMIT
Premium
LIMIT
Premium
LIMIT
Premium
LIMIT
Deductible
Premium
1
1,000,000
915
1,000,000
370
2
1,000,000
915
INCLUDED
INCL
3
1,000,000
915
INCLUDED
INCL
4
1,000,000
781
INCLUDED
INCL
ft
I—
MEDICAL PAYMENTS
COMPREHENSIVE
COLLISION
RENTAL REIMBURSEMENT
Z
Reimbursement Days
=)
LIMIT
Premium
Deductible Premium
Deductible
Premium
Per Day Covered
Premium
1
5,000
41
500
57
Soo
128
2
5,000
41
500
90
500
204
3
5,000
41
500
70
500
163
4
5,000
32
500
84
500
120
AUDIO VISUAL &
TAPES
LOAN/
NON -OWNED AUTO
DATA ELECTRONIC
RECORDS
LEASE
Premium 158
ADDED LIMITS
TOWING
& DISCS
GAP
L
Limit per
Z
VALUE
Premium
Disablement
Premium
Premium
Premium
1
2
HIRED AUTO
3
4
$500 Comp. Deductible
$500 Collision Deductible
Premium 130
CAUDEC Date Printed:05/14/18 ADD ' L INSURED COPY Page 2 of 3