HomeMy WebLinkAbout521604 KECI COLORADO INC - INSURANCE CERTIFICATE (7)ACORD, CERTIFICATE OF LIABILITY INSURANCE 10/l/2018
DATE(MMIDD/YYYY)
12/28/2016
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 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 Lockton Companies
CONT CT
NAME:
8110 E Union Avenue
Suite 7O0
Denver CO 80237
"
A/C No Ext : AIC No):
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
(303) 414-6000
INSURER A: 'I -he Charter Oak Fire Insurance Company
25615
INSURED K.E.C.I. Colorado, Inc.
INSURER B: The Travelers Indemnity Co of America
25666
1050899 5750 W. Airport Rd.
Sedalia, CO 80135
INSURER C : Pinnacol Assurance
1 NSURER D ; I-ravelers Property Casualty Co of America
25674
1 NSURER E :
,NS RER F :
COVERAGES KECCO03 CERTIFICATE NUMBER: 12439811 REVISION NUMBER: XXXXXXX
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
INSD
SUER
WVD
POLICY NUMBER
POLICY EFF
MMI
POLICY EXP
MMID /YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
Limited Jobsite
Y
N
DTC06C647481C0F18
1/l/2018
1/1/2019
EACH OCCURRENCE
1,000,000
PREMISES (ETO a ocau ence
300,000
X
MED EXP (Any oneperson)
5,000
Pollution
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
POLICY JE 0 LOC
OTHER
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
OWNEDAUTOS ONLY AUTOS
AUTOS ONLY X NON-OWNED
ONLDY
Y
N
ll7810325EI9148TIA18
1/1/2018
1/1/2019
COMBINED SINGLE LIMIT
Ea accident)
$ 1,000,000
X
BODILY INJURY (Per person)
$ XXXXXXX
BODILY BODILY INJURY (Per accident
$ XXXXXXX
X
perr. dentDAMAGE
$ XXXXXXX
$XXXXXXX
D
X
UMBRELLA LIAB
EXCESS LIAR
NCLAIMS-MADE
OCCUR
N
N
CUP0.14047221826
1/1/2018
1/1/2019
EACH OCCURRENCE
$ 5000000
AGGREGATE
$ 5,000,000
DEC) I X I RETENTION $ 10,000
$ XXXXXXX
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE N
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
N
4048534
10/I/2017
10/1/2018
X STATUTE OER
EL EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
500,000
E.L DISEASE - POLICY LIMIT
500 000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: 7519 Lemay Ave Bridge Expansion Joint. 7 he City, its officers, agents and employees are additional insured as respects General and Auto Liability if
required by written contract per policy terms and conditions. 7en(10) Day Notice of Cancellation will be provided to the City for non-payment.
CERTIFICATE HOLDER GANGELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
12439811 AUTHORIZED REPRESENTATIVE
City of Fort Collins
Purchasingg Department
PO Box 280
Ft Collins CO 80522 J
ACORD 25 (2016/031 (c)1 8 2015 C)IRP016ATION. All rights reserved
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