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HomeMy WebLinkAbout521604 KECI COLORADO INC - INSURANCE CERTIFICATE (6),aco2l� CERTIFICATE OF LIABILITY INSURANCE L.� vv2018 DATE(MMIDDIYYYY) 1 12/282016 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 8110 E Union Avenue Suite 700 Denver CO 80237 CONTACI NAME: " x A/C, No, Ext : A/C, No E-MAIL ADDRESS: INSURER AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A : 4 he Charter Oak Hire Insurance Company 25615 INSURED K.E.C.I. Colorado, Inc. 1050899 5750 W. Airport Rd. Sedalia, CO 80135 INSURER B : The Travelers Indemnity Co of America 25666 INSURER C : Pinnacol Assurance Travelers Propertysu Casualty Co of.ymenca INSURER D : ') __ 674 INSURER E : INSURER F COVERAGES KECC003 CERTIFICATE NUMBER: 12439811 REVISION NUMBFR- 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 SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX OCCUR Limited Jobsite Y N DTC06C647481 1/1/2017 1/I/2018 EACH OCCURRENCE 1,000,000 PREMISES (Ea occur ence) $ 300,000 X MED EXP (Any oneperson) 5,000 Pollution PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICYa JE LOC OTHER GENERAL AGGREGATE $ 2,000 000 PRODUCTS - COMP/OP AGG $ 2 000:000 $ )3 AUTOMOBILE LIABILITY ANY AUTO OWNAAUTOS ONLY SCHEDULED AUTOS AUTOS ONLY X AUUTOS ONLY Y N DT810325D9148 I/l/2017 1/1/2018 COMBINED tSINGLE LIMIT $ 1000 000 X BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXX X PROPERTY accidentDAMAGE $ XXXXXXX $XXXXXXX f) X UMBRELLA LIAB EXCESS LIAB I X OCCUR CLAIMS -MADE N N DTSM325D9148 1/12017 1/1/2018 EACH OCCURRENCE $ 5,000.000 AGGREGATE $ 51000,000 DED X RETENTION $ 10,000 $ XXXXXXX WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN AN OF MEMBER ER EXCLUDED' ECUTIVE N❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N 4048534 10/1 /2017 10/1 /2018 X I STATUTE OER E.L. EACH ACCIDENT $ 50n0,l000 E.L. DISEASE - EA EMPLOYEE 500,000 E.L. DISEASE - POLICY LIMIT 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Rl-': 7519 Lenlay Ave Bridge Expansion Joint. The Co, its officers, agents and empployees are additional insured as respects General and Auto Liability if required by written contract per policy terms and conditions. TerI Day Notice of Cancellation will be provided to the City for non-payment. CERTIFICATE HOLDER CANCELLATION 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 Purchasing Department PO Box 280 Ft Collins CO 80522 C % ACORD 25 (2016/03) ©1 B812015 ACORD CORPO ATION. All rights reserved The ACORD name and logo are registered marks of ACORD