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HomeMy WebLinkAbout521604 KECI COLORADO INC - INSURANCE CERTIFICATE (8)ACORD, CERTIFICATE OF LIABILITY INSURANCE 10/ 1 /2017 DATE(MM/DD/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 CONTACT NAME: A/C, No, Ext : A/C No): 8110 E Union Avenue Suite 700 Denver CO 80237 E-MAIL ADDRESS: INSURER AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A: The 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 INSURER D: Travelers Property Casualty Co of America 25674 INSURER E : INSURER F : COVERAGES KF,CCO03 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 IN D SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Limited Jobsite Y N DTC06C647481 I/l/2017 I/l/2018 EACH OCCURRENCE 1,000,000 DAMAGE ( RENTED PREMISES Ea occurrence 300,000 X MED EXP (Any oneperson) 5,000 Pollution PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PERGENERAL OLICY PEC LOC POTHER AGGREGATE $ 2.000,000 PRODUCTS -COMP/0P AGG $ 2,000 OOO $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY X AUUTO ONL� Y N DT810325D9148 1/1/2017 I/l/2018 Ea aacldeDtSINGLE LIMIT $ 1 000 000 X BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXX X Pe0acac Z 'DAMAGE $ XXXXXXX $XXXXXXX D X UMBRELLA LIAB EXCESS LIAB NCLAIMS-MADE OCCUR N N DTSM325D9148 1/1/2017 l/l/2018 EACH OCCURRENCE $ 5 00O 000 AGGREGATE $ 51000,000 DED X RETENTION $ 10,000 $ XXXXXXX C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ARTNER/E ECUTIVE a OFFICER/MEMBER EXCLUDED (Mandatory in NH) if yes .describe under DESCRIPTION OF OPERATIONS below N / A N 4048534 l0/1/2016 10/1/2017 X STATUTE DER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE 500,000 E.L. DISEASE - POLICY LIMIT 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 7519 Lemay Ave Bridge Expansion Joint. The 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. Ten(10) Day Notice of Cancellation will be provided to the City for non-payment. CERTIFICATE HOLDER GANGLLLA I IUN 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 f ACORD 25 (2016/031 ©1 B812015 ACORD CORPO TION. All rights reserved The ACORD name and logo are registered marks of ACORD