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HomeMy WebLinkAboutI-KOTA INC - INSURANCE CERTIFICATE (4)I-Kf�INC-01 DFNFRFR ,4coR�` CERTIFICATE OF LIABILITY INSURANCE �.►� DATE(MM/DD/YYYY) 03/05/2018 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 CONTACT Virginia Shaw NAME: (A/cC, No, Ext): (720) 330-7903 jvc, No):(303) 799-0156 CCIG RECEIVED 5660 Greenwood Plaza Blvd. Suite 500 Greenwood Village, CO 80111 MAR 0 9 201� noDAIE s: GinnyS@thinkccig.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Westfield Insurance 24112 {{ INSURED Manager's Office I -Kota Inc City INSURER B : Pinnacol Assurance 41190 INSURER C: The Hanover Insurance Co. 22292 Attn: Riley McLaughlin- 90 Galapago St INSURER D : Denver, CO 80223 INSURER E : INSURER 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 PAID CLAIMS. - -- ----- INSIR LTR TYPE OF INSURANCE ADDL SUBRi POLICY NUMBER -BY -- POLICYYEFF POLICY �E`XP --- LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000'000 CLAIMS -MADE X OCCUR XPREMISES CMM0982161 03/10/2018 03/10/2019 DAMAGES( RENTED EMI E Ea ccurren 500,000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: POLICY PELT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBA Ea acciden SINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ X ANY AUTO CMM0982161 03/10/2018 03/10/2019 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE Per accident $ HIRED NON -AWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS -MADE CMM0982161 03/10/2018 03/10/2019 AGGREGATE $ 5,000,000 DED I X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N /A 4138898 04/01/2018 04/01/2019 X PER H- TAT TE ER E.L. EACH ACCIDENT 1,000,000 $ E.L.DISEASE -EA EMPLOYEE 1,000,000 $ E.L. DISEASE - POLICY LIMIT _ 1000000 $ ' ' If yes, describe under DESCRIPTION OF OPERATIONS below C Lease/Rented Equip IH4959369305 06/25/2017 06/25/2018 Limit 250,000 C RC Valuation IH4959369305 06/25/2017 06/25/2018 Deductible 1,000 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, ACCORDANCE WITH THE POLICY ROVISIONSCE WILL BE DELIVERED IN 300 LaPorte Avenue Fort Collins, CO 80521 EPRESENTATIVE AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD