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HomeMy WebLinkAbout111775 KUBAT EQUIPMENT & SERVICE CO - INSURANCE CERTIFICATE (3)CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/18/2016 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 endorsements . PRODUCER CONTACT NAME: g L@I. h Pullen Moody Insurance Agency, Inc. PHONE (303)824-6600 FAX (303)370-0118 A/C Noll: 8055 East Tufts AvenueADMDRESS:leigh.pullen@moodyins.com Suite 1000 INSURE S AFFORDING COVERAGE NAIC S Denver CO 80237 INsuRERA:Homeland Ins co of NY 34452 INSURED INSURER B :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: COVERAGES CFRTIFICATF NIIMRFR•16/17 No forms/No TTmh eGvletnnl wnUlece. 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POUCY NUMBER MM/DDrrYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE'M RENTEDPREMISES Ea occurrence $ 150,000 MED EXP (Any one person) $ 5,000 7930040310001 12/1/2016 12/1/2017 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � �� LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY EOMaBINdeDtSINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUUTOSS AUTOS EBA0219301 12/1/2016 12/1/2017 BODILY INJURY (Pid (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS MADE DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A 4119184 12/1/2016 12/1/2017 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1 000 000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) I t MULUtK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 330 South College Avenue ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE Leigh Pullen/LEIPUL�e��`�t�vL(�¢�L ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD I NS025 (201401)